Caceres’ Corner Case 161 (Update: Solution)

Dear Friends,

I am doing spring cleaning of my cases and this week I am showing two of them. Radiographs belong to two unrelated middle-age patients with chest pain.
What do you see?

Check the images below, leave your thoughts in the comments section, and come back on Friday for the answer.

Case 1

Case 2

Click here for the answer

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    May 2017
    DISCUSSION 12 Comments

    12 Responses to : Caceres’ Corner Case 161 (Update: Solution)

    1. Mk says:

      In the firts one, there are at least two left costal fractures (pathologic vs traumatic) and a nodular lesion at the right 8 costal arc probably extrapulmonar (chronic fracture?)

      In the second one, the right 6 costal arc is increased in size and density, probably metastasic or Paget.

      • Jose Cáceres Sirgo says:

        Can you differentiate metastases from Paget?

        • MP says:

          I agree with MK’s findings. Both Paget and osteoblastic mets can present with increased bone size, however, Paget also demonstrates trabecular coarsening and cortical thickening with an intact medullary space. I think the rib in question is mostly sclerotic and I do not see an intact medullary space. Therefore, I would think osteoblastic mets. Comparison with previous radiographs or CT would be helpful to look for other sclerotic lesions.

        • Mk says:

          In paget disease there is an enlargement of the cortical and increased in size of the bone, with loss of diferentiation between cortical and-medullary, so I think it is a Monostotic costal Paget.

    2. Ren says:

      1. There are fractures in left 8 ,9 ribs and a nodular lesion at the right 8 rib likely extrapulmonary ( fracture? With associated hematoma)
      2. the right 6 costal arc is Expanded and increased in density, metastasic/pagets/fibrous dysplasia

      • Jose Cáceres Sirgo says:

        In case # 2 you are telling the patient that either she/he has widespread malignant disease or a benign lesion. Can you narrow down the diagnosis?

    3. sht says:

      1. Sclerotic nodule right 8th rib

      2. Hyperdense rt 6th rib – Paget

    4. dr Noor says:

      first one show fractures in the left lower ribs and 2nd one show icreased bone density and widening of the right 5th rib as a whole suggestive if pagets

    5. EIAA says:

      1st case male modularlesion in left rib 8,9
      Likely posttraumatic calus

      2nd case female right 6 rib enlarged sclerotic likely Paget d.

    6. genchi Bari italia says:

      …..gentilissimo PROF., abbiamo due casi, uno con osteoporosi e frattura con callo osseo poco calcifico….l’altro , all’opposto,con diffusa osteosclerosi e lieve aumento di volume dell’osso…..alla base non ci sono malattie metastatiche, ma solamente disturbi del metabolismo osseo, in difetto ed eccesso…..entrambe possono dare dolore….penso così’ di interpretare il tuo insegnamento…..grazie sempre…..con stima da Bari…..