Today’s radiographs belong to a 70-year-old man with a chronic cough. What do you see?
Check the images below and leave your thoughts in the comments section. More images will be shown on Wednesday, followed by the answer on Friday.
Dear Friends, now showing images of enhanced CT. Do they help?
Findings: the PA radiograph shows a moderate widening of the upper mediastinum (A, arrows). The lateral view demonstrates a retro tracheal opacity in Raider’s triangle (B, arrow), bowing forward the posterior wall of the trachea (B, red arrow).
Enhanced axial and sagittal CT show a retro tracheal cavity (C-D, arrows) with an air-fluid level (C, red arrow). There is a bubble of air anteriorly (C-D, yellow arrows), which marks the oesophageal lumen.
The findings suggested a Zenker diverticulum, which was confirmed with a barium oesophagogram (F, arrow). Review of a CT taken seven years earlier shows air bubbles in the same location (E, circle).
Final diagnosis: unsuspected Zenker diverticulum
Congratulations to tr, who made the diagnosis and to Pratiba, who was the first to detect the opacity in Raider´s triangle.
Teaching point: remember to look at Raider’s triangle in the lateral view. It may prove very rewarding, as happened in this case.
