Caceres’ Corner Case 174 (Update: Solution!)

Dear Friends,

Today I am showing radiographs of a close friend of mine, a 76-year-old man who had an abdominal CT for renal stones. Some abnormalities were detected at the base of the right lung, and chest radiographs and CT were done.

What do you see?

This is the last case of 2017. Next case will be presented on Monday, January 8. Wish you the best for the coming year!

Check the images 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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    Dec 2017
    DISCUSSION 15 Comments

    15 Responses to : Caceres’ Corner Case 174 (Update: Solution!)

    1. Mk says:

      Good morning!

      In the x-rays: Right pleural effussion with an alveolar consolidation with pleural based (infeccion?, pulmonary infarct?).

      On coronal CT there is not pleural effusion (different day than x-ray?), but I think there is a pericardiac effusion…

      • Mk says:

        Indeed the attenuation of the pericardial tissues is like fat not water so not pericardial effusion.
        In the CT there is an increased attenuation of the right costophrenic fat: fat necrosis? Perhaps the patient has pleural effusion with right segmental atelectasi because of the pain, and now after a few days we can see the fat necrosis.

        Has the patient had any thoracic sympton?

    2. Jose Caceres says:

      You are missing the obvious. There is segmental affectation of RLL. What may cause it?

    3. MP says:

      Bronchogenic carcinoma…

      • Jose Caceres says:

        Come on, you can do better! How many low-density carcinomas have you seen?

        • MP says:

          So one possibility would be a bronchial hamartoma which according to the literature is the most common benign endobronchial lesion. CMAJ. 2011 Sep 20; 183(13): E1039

          Another possibility is an endobronchial lipoma which according to a literature search would be a rare cause of bronchial occlusion.

    4. genchi bari italia says:

      ….buon Natale…..lipoma endobronchiale con atelettasia ed adenopatie ilo-mediastiniche.

    5. Pogo says:

      The frontal radiograph shows inhomogenous haziness of the right lower zone. no silloutment of the cardia or diaphragm. both CP angles are clear, however the right dome of diaphragm is directing laterally (subpulmonic effusion?)
      The right lateral radiography is showing linear atelectsis of one of the segment of right lower lobe. No bluting of the posterior costophrenic angle.

      coronal CT image is showing a small low density mass in the right lower lobe bronchus.

      the diagnosis is endobronchial carcinoid with partial atelectasis posterior segment of right lower lobe.

      • Jose Caceres says:

        If I may disagree, it would be very unusual to see a low-density carcinoid, specially after contrast enhancement.