Caceres’ Corner Case 177 (Update: Solution)

Dear Friends,

I am presenting an unknown case (no final answer yet), but I believe that I have the answer, pending further studies. Radiographs belong to a 67-year-old woman and were taken during a routine check-up. Will show more images on Wednesday.

What do you see?

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


As promised, here are the two additional images. Do they help you to reach a conclusion?

Click here for the answer

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    Feb 2018
    DISCUSSION 27 Comments

    27 Responses to : Caceres’ Corner Case 177 (Update: Solution)

    1. Mk says:

      Good morning!!!

      There is a pleural lesion at right hemithorax, for example an hematoma because of costal fracture (any hystory of trauma?).

      In the lateral x-ray the right hilum has a particular round shape, but I cant see any anomaly in the AP proyection.

    2. Genchi bari italia says:

      …..guarda la trachea , in AP e LL, a livello della biforcazione…..impronta e stenosi ab -estrinseco…..

    3. MAAD says:

      2 finding
      Pathologische Pleura thickening rightside in level of lowerfeld.
      Thickening of the right paratracheal line with deviation of trachea to liftside.
      DD Pleural carcinomatosis

    4. Gaborini says:

      Extrapulmonary lesion laterally on the right, it might as well be a schwannoma, although I do not see any additional finding supporting this diagnosis.
      Saludos desde Hungría, gracias.

    5. Adilson Cordeiro says:

      Hello. I see a deviation in the trachea or stenosis.

    6. Sadaf says:

      Rt pleural based opcity/ fusiform thickening of right 7th rib, rounded opacity behind aortic arch anterior to trachea causing its compression

    7. Limiatis Panagiotis says:

      Pleural thickening at level of 7th & 8th rib on the RT. Deviation of the trahea to the RT. CT scan is recommended .

    8. mariam says:

      on the right there is pleure thikening and azygoesophagal recess is deviated.

    9. Roy Thomas says:

      The Left sided Pulmonary vascular shadows are significantly attenuated. I would proceed with CTPA to exclude PE or other pulmonary vascular pathology. In the lateral view I’m also concerned of the prominence ascending aorta. Hence I will tailor the CT in such a way as to get adequate enhance the of both aorta and pulmonary arteries.

    10. Alina Fontul says:

      Lipoma subpleural?

    11. Viviane says:

      It can be my imagination, but, to me, there is a tracheal deviation to the left. Does anyone agree?
      And there is a tracheal narrowing below aortic arch.

      • Jose Caceres says:

        I agree with you about about the tracheal deviation. Patient had a small goiter.
        No tracheal narrowing, though 😉

    12. Mk says:

      Good morning!

      At CT we can see an insuflated focal blastic rigth costal with a round lytic outside lesion with no desmoplastic reaction (no aggresive).

      Osteoid osteoma?

    13. bujar says:

      primary rib tumor.
      with no pain – enchondroma
      with pain, more night – osteoid osteoma

    14. Trinity says:

      After Ct , osteolytic expansile lesion rt 6th rib with ground glass cortical thickening and with associated soft tissue component seen. ? Fibrous dysplasia

    15. Trinity says:

      Given the age of patient i would alsolike to keep mets as my differential

    16. Daniel says:

      Could be mets (breast?), paget’s, lymphoma, eventually even a lymphangioma… i think osteoid osteoma would hurt and enchondroma would be different in the images…

    17. Coffee says:

      There is focal periphery extrapulmonary opacity at right lung, along ribs, no gross cortical destruction.
      CT, there is focal sclerotic change with lucency or bony gap along right rib, with minimal adjacent pleural thickening, no gross associted soft tissue mass, possibly post traumatic change, tumor such as fibrous dysplasia, and osteoid osteoma if night pain is present

    18. KHALEEL says:

      peripheral pleural thickening at the right lower lobe on ap view-( any chronic condition) with increased vascular markings of right lower lobe brach.

      In lateral view I found the decreased space between heart & vertebrae-minimum pericardial effusion which usually accumulates on posterior of heart ?

      ofcourse the round thing in lat view is right pulmonary artery.

      I am justv a medical student so i only describe the me to improve.thank you sir

      • Jose Caceres says:

        I am glad you are participating. Do so and wait until Friday to see if the answer coincides with your opinion.
        You can also look at previous cases and at Dr Pepe Diploma

    19. David says:

      Was this proven to be a foreign body granuloma in the end Dr?

      • Jose Caceres says:

        The patient remains asymptomatic and no biopsy was done. I did a follow-up CT last November and the lesion is unchanged. It is obvious that the lesion is benign. Given the prevalence of fibrous dysplasia in the ribs, perhaps this is the best possibility, instead of a foreign body granuloma
        (always think of a rare manifestation of a common disease, rather than a common manifestation of a rare disease).