Caceres’ Corner Case 179 (Update: Solution!)

Dear Friends,

I want to present today a case that I saw two months ago. The radiographs belong to an asymptomatic 55-year-old man. Will show more images on Wednesday.

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

1. Enlarged azygos vein
2. Enlarged ymph node
3. Mediastinal mass
4. Any of the above

As promised, here are two additional CT images. What do you see?

Click here for the answer

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    Mar 2018
    DISCUSSION 15 Comments

    15 Responses to : Caceres’ Corner Case 179 (Update: Solution!)

    1. MK says:

      Good morning!

      I think there is a right paratracheal lesion (in the lateral view it seems to be an adenopathy more than an enlarged acigos vein).
      There is an spiculated lesion overlaying the right hilum.

      I think we have to rule ot malignancy with a CT.

    2. Trinity says:

      Chest radiograph AP view shows prominent and enlarged left hilum which is seen in lateral view also. There is paratracheal increased density seen on the left side just superior to the aortic knuckle, with continuation inferiorly and sail like traingular opacity seen upto left hemidiaphrgam. This is seen on lateral view as prominent oblique fissure.
      It seems like left hilar lymphadenopathy with partial collapse left lower lobe. Suggest CECT chest.

    3. Trinity says:

      Compensatory hypertrophy of the right lung is seen with herniation across the midline in anterior mediastinum.
      Azygous vein also appears prominent.

    4. Renan Brandão Rambaldi Cavalheiro says:

      Good evening Doctor Caceres! I have been following your teachings since 2015 and as a fifth year student in Brazil, I think I should start commenting on this blog instead of just being a silent reader.

      Well, I think that there is an enlarged azygus arch to the right, opposed to the aortic knob, better seen in the lateral view. Also, I agree with MK about the spiculated lesion overlying the right hilum. Maybe an enlarged paratracheal lymph node? I think that these two lesions somewhat overlie each other in the lateral view.

      Looking forward to the images on Wednesday!

      • Jose Caceres says:

        Dear Renan, welcome to the blog! Would like to know your opinion about the new images.
        Thanks for participating

    5. Atef Ennahas says:

      Filling retrosternal space.
      Right ventriculat heart configuration.
      Congested lungs

    6. radres says:

      My DDX are:
      1 – lymphadenopathy, could be sarcoidosis (1-2-3 sign), right paratracheal and bilateral hilar LN enlargment (and the patient is asymtpmatic which corellates with stage 1 sarcoidosis)
      2- right hilar mass.
      Looking forward to see the diagnosis!

    7. Coffee says:

      There is prominent density at rigth paratracheal region , possibly enlarged noe or prominent azygos vein.
      Further CT show absent hepatic segment of IVC with azygos continuationof the IVC.

    8. MK says:

      No right hiliar lesion.

      Enlarged acigos vein with agenesia of the inferior vein cava with polisplenia, but it is difficult to confirm this with only 2 images.

    9. BigD says:

      Intra tracheal

    10. Jessica Chasi says:

      Enlarged acygos vein

    11. MOHAMED says:

      This is Azygos as thers is no IVC.

    12. Nevien R.Fares says:

      Prominent azygous vien

    13. Lusine says:

      Enlarged azygos vein