Caceres’ Corner Case 164 (Update: Solution)

Dear Friends,

Today I want to test your prowess in plain film interpretation. The PA radiograph belongs to a 79-year-old woman with a cough and haemoptysis. What do you see?

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

Click here for the answer

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    Sep 2017
    DISCUSSION 14 Comments

    14 Responses to : Caceres’ Corner Case 164 (Update: Solution)

    1. tr says:

      -poor inspiratory effort
      -Enlarged cardiac silhouette.
      -blunting of the left lateral recess.
      -oblique vertical line over the left side of the mediastinum giving an impression of a triangular retrocardiac opacity, it might be a deviated anterior junctional line.
      -deformed appearance of the left hilum with hazy illdefined opacity above it, and looks mildly superiorly displaced.
      -Aortic konb margin is clear.
      -no mediastinal shift.
      Impression: the findings are quite confusing, and i suggest left upper lobe collapse with associated left pleural effusion, and compensated cardiomegaly.

    2. stalf says:

      No lateral? 🙂
      Left hilus slightly enlareged and irregular with increased vascular markings in lul, and possible left sided effusion.
      Slight ipsilateral mediastinal shift to the left.
      Could be a mass obstructing bronchus for apicoposterior segment of lul.

    3. MK says:

      There is a loss of volume of the left hemithorax and an increased density proyected over the LUL. The left bronchial is horizontalized and elevated, perhaps thinner than the right one. I think that endobronchial/hiliar lesion is a good option with secundary atelectasis.

      I can see an abnormal line that is proyected over the aortic knob and goes down…

      The prominent aortic knob desplaces the trachea to the right side.
      Probable cardiomegaly in spite of the poor inspiration.

    4. Stevan Vasiljević says:

      Left side volume loss with elevated diaphragm and elevated hilum, hilar opacity without clear upper margin, hazy opacification in the left middle and upper zone – all point to LUL collapse.

    5. Lucretius says:

      We think there is left side loss of volume with an opacity of LUL, that can be an partial collapse. There is also left side effusion. Allergic bronchopulmonary aspergillosis and lung mass are diagnostic possibilities.

    6. Allahrasan says:

      Rotation toward left side results jazzy left co angle
      Despite rotion t would suggest presnce of subtle mass lesion in left hula
      Ct suggest for confirmation

    7. LS says:

      Rotated image.
      Left upper lobe collapse.
      Left sided pleural effusion.
      Cardiomegaly possibly due to mitral valve disease.
      Calcifications in the aortic knob.
      Degenerative changes of the spine.

    8. Zulu says:

      LLL collapse (sail sign?) due to central mass that obstruct the the left main bronchus which is not clearly visible.
      Left pleural effusion.
      The patient rotated a little bit to the right.

      • Jose Caceres says:

        LLL collapse would be not compatible with an elevated hilum, unless you are thinking of a torsion of the lobe.

    9. Elesfenoides says:

      Interesante como siempre 😉

    10. sabry says:

      cardiomegally (ventricular ) , pulmonary hypertension with left upper lobe collapse