Caceres’ Corner Case 73 (Update: Solution)


Dear Friends,

Presenting the last case before Summer vacation. Muppet needs quality time to replenish his energy (July and August) and will return in September with more interesting (and teaching) cases.

These radiographs belong to a 52-year-old male with a cough. The answer has now been added, but you can still leave your thoughts and diagnosis in the comments section, below, before you check it.

1. Mediastinal fat
2. Dilated SVC
3. Lymphoma
4. None of the above

52-year-old male, PA chest

52-year-old male, PA chest

52-year-old male, lateral chest

52-year-old male, lateral chest

Click here for the answer to case #72.

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    Jun 2013
    DISCUSSION 18 Comments

    18 Responses to : Caceres’ Corner Case 73 (Update: Solution)

    1. ashraf abohadeed says:

      chest x ray frontal and lateral views .
      expiratory view
      widening of superior mediastinum with straight radial mediastinal border . extending above clavicle ,so it is middle or posterior mediastinal dilated SVC , or excessive mediastinal fat .
      however i will repeat the frontal view in full inspiration , then ct scan may be advisable

    2. gus says:

      pericardial effusion
      Posterior displacement of epicardial fat pad by effusion on lateral view.

    3. Andrés Roca says:

      Convendría una proyección en inspiración pero lo mas probable es que sea una vena cava superior dilatada

    4. Katerina says:

      There is widening of the paratracheal stripe extending above the clavicle, suggesting (as Ashraf Abohadeed already mentioned)a middle or posterior mediastinal lesion, but I think there is also an retrocardiac opacity as well as an enlarged left hilum .
      I cannot distinguish the major fissures in the lateral view, but I think that there is a downward displacement of the left hilum.
      So, may be it is a LLL lung carcinoma with left hilar and right mediastinal lymph node metastases.

    5. omar says:

      I think the opacity is anterior obliterating the retrosternal space in Lat. view , it is homogenous with sharp Rt border in PA film , no tracheal shift , no other abnormalities …
      so mediastinal fat may be the most likely choice.

    6. genchi bari italia says:

      Quello che colpisce, a prima vista, è lo svasamento mediastinico alto a dx, con lieve medializzazione della trachea.Inoltre , sempre in AP, attraverso l’ombra cardiaca, si vede una irregolare opacità, sotto l’ilo di sx , che pertanto è “slivellato”, rispetto al destro.In LL ,il profilo inferiore dell’ombra cardiaca è sfumato, mentre il bronco principale di sx non è altrettanto ben definito.Penso allora che Katarina ha visto bene, formulando la diagnosi di CR polmonare ilare sx, con linfoadenopatie mediastiniche.NB. Alice è già in vacanza?

    7. Dr Strangelove says:

      What is that drop-like nodule at the right border of the opacity ?
      Another dense azygos lobe ?

      • Jose Caceres says:

        The opaque azygos lobe is less dense in its lowermost aspect. Answer tomorrow

    8. gus says:

      This hyperlucent lesion retrocardiac in the base with the retraction of the left hilum could be a intralobar seqestation?

    9. A B Jay says:

      small segment of pulmonary vessel narrowing in left perihilar region most likely extrinsic along with distended SVC.
      ? pulmonary arteriovenous communication.

    10. A B Jay says:

      adding to my previous comment buldging right heart border seen in PA view ,and prominent IVC seen on lateral view reflect increased burden on right atrium

    11. Alice says:

      late again i am really busy right now
      i will have to think some more one this one but could it be right upper lobe atelectasis?
      there seems to be volume loss of right lung
      right hilum seems to have moved upwards

    12. genchi bari italia says:

      grazie “mitico” del suggerimento a Katerina( e faccio mia l’osservazione di Alice): e se il tutto fosse un mediastino “vascolare”?. Un doppio arco aortico,spiegherebbe lo svsamento mediastinico alto a dx, con lieve medializzazone della trachea e l’ilo sx più piccolo, ovvero uno “sling” dell’arteria polmonare sx.N:B. il dottor Ricardo Pruna(FBC Barcellona), il 27 settembre a Bari, per un convegno di ecografia sportiva.Buone vacanze a te ed a tutti i cari colleghi.

    13. genchi bari italia says:

      Bravissima Alice! Regola kiss è stata rispettata:pensare sempre alle cose SEMPLICI !Atelettasia lobo superiore dx, con ilo dx stirato in alto.