Caceres’ Corner Case 171 (Update: Solution!)

Dear Friends,

Today’s images belong to a 38-year-old woman treated with antibiotics for a sore throat with fever. Six days later she goes to the ER with left chest pain and moderate dyspnea.

What do you see?

Dear friends showing two more images to facilitate your diagnosis. Final answer on Friday!

Click here for the answer

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    Nov 2017
    DISCUSSION 11 Comments

    11 Responses to : Caceres’ Corner Case 171 (Update: Solution!)

    1. MP says:

      I see a faint rounded soft tissue density in the left lower lung zone which seems to be arising from the chest wall. I do not see any associated fractures or rib destruction and the border does not seem completely defined to me. There may also be some linear atelectasis in this region.

      Considering her chest pain and dyspnea I would consider a pleural fibroma.

    2. Coffee says:

      There is focal opacity with bulging contour and few reticular opacity at periphery of left lower lung zone with blunting left costophrenic angle, seem to be eliptical shape or more elongated in lateral view, possibly pleural lesion such as pleuritis with loculated pleural effusion or empyema.

    3. Mk says:

      Hello! There is an obliteration of the left costophrenic angle and a well defined internal margin of a lesion that can be pulmonary or extrapleural (I think I need a CT to define the localization). The hystory remembers me a Lemierre syndrome with pulmonary septic embolism (in this case the lesion will be intrapulmonary ). Any signs of yugular thrombophlebitis vein?

      • Jose Caceres says:

        More images will be shown next Wednesday

        • Mk says:

          Alveolar periferic infiltrates (bigger in size and number in LLL-septic embolims).
          At vascular reconstruction the left yugular vein is not visible so a thrombosis have to be suspected.

    4. TR says:

      peripheral incompletely round opacity over the left lower zone that cannot be seen on the lateral view, the lesion is probably related to the chest wall/breast, and the haziness over the left lateral costophrenic recess, I think, can be explained by perilesional soft tissue reaction/edema.

    5. Tr says:

      I am not so sure about what I see in the angiogram, the left common carotid looks blocked shortly after its origin, which I think explains the nonvisualization of the left jugular vein.
      Peripheral pleural based opacities in the left lung suggesting embolic event.
      I could not figure outvthe connection!

      • Jose Caceres says:

        The flow in the left carotid was OK. The left jugular was thrombosed.
        I didn’t select the best image. Sorry.

    6. TR says:

      in this case I suggest leimierre syndrome.

    7. TR says:

      may I ask why the neck vessels angiogram was done?, was there any symptoms in the neck?.
      thank you

      • Jose Caceres says:

        Remember that the patient originally had a sore throat. After the chest CT a Lemierre sindrome was suspected and a Doppler study confirmed thrombosis of the jugular vein. Personally, I think the MR study was unnecessary, but it was done, anyway.