Caceres’ Corner Case 189 (Update: Solution!)

Dear Friends,

Today’s images belong to a 63-year-old smoker with a persistent cough.
What do you see?

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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    Sep 2018
    DISCUSSION 5 Comments

    5 Responses to : Caceres’ Corner Case 189 (Update: Solution!)

    1. TR says:

      There is a subtle widening of the mediastinum on the PA view, and a rounded opacity on the lateral view displacing the trachea anteriorly ( middle mediastinal lesion).
      The is also a small retrosternal consolidation.
      Impression: middle mediastinal mass (developmental cyst, lymphadenopathy, vascular lesion, neurogenic tumor..).
      The retrosternal lesion might be a tumor or infection.

    2. Diogo says:

      There is a large mass displacing the trachea anteriorly. A dilated anomalous right subclavian artery (Kommerell diverticulum) would be a nice guess.

    3. MK says:

      Hello!! There is a medium mediastinal lesion that displaces anteriorly the trachea. Perphaps a vascular anomaly: double aortic arc vs aberrant subclavia with kommerell´s diverticulum?

    4. muppet biggest fan says:

      Hello Professor,
      clearly we are dealing with a mediastinal abnormality and as muppet always says mediastinum is mostly composed of vessels 🙂
      – on lateral view there is quite big opacity in middle mediastinum, shifting the trachea to the front
      – below that, just above the carina there is (or at least I think there is ;P) also more subtle modeling of the trachea from the front
      – on front cxr i don’t see a typical aortic knob on the left side, suggesting RAA, but there is some shadow crossing the tracheal line just above carina – my bet is on double sided aortic arch