Caceres’ Corner Case 184 (Update: Solution!)

Dear Friends,

Today we are presenting a pre-op chest radiograph for knee surgery of a 48-year-old woman. What do you see?

Check the image below and leave your thoughts in the comments section. More images will be shown on Wednesday, and the final answer on Friday.


Dear Friends, these additional images were taken five years ago after an episode of abdominal pain.

Do they help you?

Click here for the answer

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    May 2018
    DISCUSSION 34 Comments

    34 Responses to : Caceres’ Corner Case 184 (Update: Solution!)

    1. Katarzyna says:

      There is a pulmonary nodule in the left lower lobe with well-defined margins. Maybe an AVM?
      Marked scoliosis of the thoracic spine.

    2. John says:

      Pulmonary AVM

    3. Amel says:

      Thorax PA film
      -increased bronchovascular pattern (vascular: arterial origin)
      -1 nodule in upper right lobe, 2 nodules in the lower right lobe,1 in the left upper lobe, and 1 more at left lower lobe near the left costophrenic angle
      -Thoracic Scoliosis with left convexity

      Otherwise everything looks completely normal to my n00b eyes ^^

    4. Trinity says:

      Multiple -two in RLZ and three in LLZ- well defined lesions with smooth margins are seen in2 BLZ. No calcification or cavitation seen within these lesions. Being in periphery and basal lung fields, multiple pulm modules may represent,
      1. Mets.
      2. Rheumatoid Lung nodules.

      • Jose Caceres says:

        Asymptomatic patient, no known primary.

        • Trinity says:

          The right cardiac silhouette and right paratracheal region show increased density with loss of normal contour. Is it rotation?

          • Jose Caceres says:

            Probably due to the scoliosis. Don’t worry about it. More information tomorrow.

    5. Anisha Garg says:

      Multiple well defined lesions with smooth margins are seen in Bilateral LZ with no calcification or cavitation .

      Aortic calcification is displaced medially. Aortic dissection needs to be ruled out.

      Rheumatoid nodules

    6. Elsa says:

      Multiple bilateral well defined nodules..hamartomas?

    7. Amri says:

      Nothing on skin?

    8. Mohamed shahbour says:

      Multiple well defined nodules at both lungs
      Smooth regular margin for d.d
      Rh lung nodules

    9. Stef says:

      Maybe multiple fibroadenomas of breast. Pkus escoliosis.

      • Jose Caceres says:

        In my experience, fibroadenomas of the breast are not seen in the chest radiographs unless they are calcified 🙂

    10. BigDee says:

      Bilateral multiple nodules, right border of the heart is not seen, is it a pectus excavatum associated?

      • Jose Caceres says:

        Pectus causes blurring of the right heart border and, sometimes, apparent cardiomegaly. It has no relationship to pulmonary nodules. And in this case I believe the right heart border is visible 🙂

    11. Deresh Natali says:

      I see 4 nodules in basal parts of lungs, with well-defined margins. Scoliosis. Of course, bilateral multiple nodules – “o, metastases” – shablon and first thought. But it can be granulomas. What is the cause of knee surgery?

      • Jose Caceres says:

        Surgery was scheduled for a torn meniscus. No relationship to the nodules

    12. Sb says:

      Bilateral multiple nodules
      And left side 3 4 5 bifid rib anomalies

    13. genchi bari italia says:

      Neurofibromatosi tipo 1: neurofibromi cutanei e scoliosi.Saluti carissimi PROF.

    14. MK says:

      Well defined bilateral pulmonary nodules (are they slightly cavitated?) in a normal parenchimal.

      Autoinmune process? (Wegener, reumathoid…)

    15. Jose Caceres says:

      Now you have all the information. Let’s summarize the findings:
      Basal nodules discovered accidentally, slow-growing in an asymptomatic woman.

    16. Katarzyna says:

      Pulmonary hamartoma fits the best.

    17. Marco S says:


    18. Katarzyna says:

      What a very interesting case! Thank You Prof. Caceres