Caceres’ Corner Case 183 (Update: Solution!)

Dear Friends,

Today I am showing a pre-op chest radiograph for varices of a 79-year-old woman. A radiograph taken five years ago was normal.
What do you see?

Check the image below and leave your thoughts in the comments section. Will show more images on Wednesday and the answer on Friday.

Dear friends,

showing new images of enhanced CT.
Good luck!

Click here for the answer

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    Apr 2018
    DISCUSSION 10 Comments

    10 Responses to : Caceres’ Corner Case 183 (Update: Solution!)

    1. Trinity says:

      Hello sir,
      There is increased density and size of both hila with loss of lateral convexity- bilateral hilar lymphadenopathy left more than right.

      Two well defined round opacities are seen in LMZ-suggestive of pulmonary nodules- may represent metastatic nodules in the given age group.
      The left hemidiaphrgam is also elevated more than right.
      Linear reticular opacities in LLZ are seen parallel to left hemidiaphrgam, may be lymphangitis carcinomatosis.
      My differential would be
      1. Ca lung with satellite nodules and hilar lymphadenopathy.
      2. Mediastinal lymphadenopathy with pulmonary mets.

      • Trinity says:

        Left hemidiaphrgam elevated due to mediastinal invasion and phrenic nerve palsy. Collapse of left lung not seen.

        • Ghizlane says:

          Hello Trinity,
          Your answer and analysis make sense to me. But what do you think about the right pulmonary apex?
          Best regards.

          • Trinity says:

            Thank you sir for your comment . Agree with your observation of right apical opacity, may be pleural thickening. Regards.

            • Jose Caceres says:

              Apical opacity is not significant in this case. Look at the new images posted today.

    2. Mk says:


      Prominents nodular hilar (adenopathy).
      Two high density nodular lesions in left hemithorax, but I would like to see the lateral view to confirm that they are inside the lungs…
      There is a lineal high density above the right hilum …?
      Elongated aorta

    3. Enas says:

      Bilateral hilar masses with two lt mid zonal large nodules and mild elevation of lt hemidiaphragm

    4. Trinity says:

      CECT scan shows left hilar mass and heterogenously enhancing pulmonary nodules left upper lobe. The right hilum appears normal.
      Left hilar mass may be carcinoma lung with mets to LUL .
      Thank you sir. Regards.