Caceres’ Corner Case 83 (Update: Solution)


Dear Friends,

Since I am an old codger, I am only allowed to look at pre-op chest films. As one young member of staff told me: you may be better than us, but we are faster because we read all of them as normal!

Today I am showing two pre-op chests. Would you read them as normal? If not, what do you see? Leave your comments below and come back for the answer on Friday.

Patient 1 PA

Patient 1 PA

Patient 1 lateral

Patient 1 lateral

Patient 2 PA

Patient 2 PA

Patient 2 lateral

Patient 2 lateral

Click here for the answer to case #83

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    Jan 2014
    DISCUSSION 30 Comments

    30 Responses to : Caceres’ Corner Case 83 (Update: Solution)

    1. petra says:

      Patien1: nodular expansion in right cardiophrenic angle, which is not mediastinal lipomatosis because of its shape. It may be atypic lymph node or expansion of right atrium or atypic axial hernia or mediastinal expansion.

      Patient 2- norma.

      • maka says:

        Patient 1 . on the medial sinus there is intense round opacity-suggested lipoma
        Patient 2. i think there is norma

    2. Dinesh says:

      Patient1: well defined oval radio dense opacity in right cardiophrenic angle with coarse calcification in centre and no effusion or hilar LN. Lateral film confirm the intra pulmonary location (solitary pulmonary nodule- most likely benign) 1st d/d hamartoma.

      Patient 2: increased translucency in rt lower lobe at cp angle area and reduced vascular markings – may be due to emphysematous changes

    3. Ines says:

      Case 1: right lower lobe, paramediastinal round opacity – lung node, sequestrum
      Case 2: left parahilar irregular opacity – lung node, lymphadenopathy

    4. maria says:

      patient 1-solitary pulmonary nodule in right cardiophrenic angle on PA, with calcifications, probably benign-hamartoma, but need previous films for comparison. Patient 2 has a straight back syndrome, otherwise normal

    5. Adela says:

      Patient 1: Solitary pulmonary nodule in right cardiophrenic angle, with calcifications, probably hamartoma. Patient 2: Lineal imagine at right pulmonar base, below 10º costal arch that remember me “cimitarra sign”.

    6. Jonathan says:

      1. R cardiophrenic angle mass/nodule.
      2. Focal opacity along posterior aspect of the trachea on lateral at the level of RUL bronchus. Hard to see on PA view; perhaps in L hilar region?

    7. Murzin says:

      1. as colleagues said right cardiophrenic nodular opacification with calcification (calcified lymph node? hamartoma? pericardia cyst with wall calcification? pericardial fat necrosis with calcification?- long ddx)
      2. right cariophrenic angle tubular opacity- it is agled the other way around compared to scimitar syndrome (no cardiac shift, no lung hypoplasia) i would consider a. rare PAPVR drainage with hepatic vein b. some king of a shunt or by-passing vein consisten with portal hypertension or Budd-Chiari

    8. Xose says:

      Hi Dr. Caceres
      I understand you are getting older

      Case 1. Right costophrenic angle nodule. Well delimited, pop-corn calcifications. My diagnosis, hamartoma.

      Case 2. More difficult. Left lower lobe nodule, retrocardiac. I cannot see any calcifications. May be fat containing?

    9. Yp says:

      Case 1. Hamartoma
      Case 2. Retrocardiac opasity (bronhiectasia)

    10. gus says:

      patient 1-solitary pulmonary nodule in right cardiophrenic angle( pericardial cyst,pericardial fat necrosis,lymphadenopathy,
      fibrous tumour of the pleura,Morgagni’s hernia, Hamartoma)
      patient 2- bronghiectasis

      • Dr. Pepe says:

        In my opinion, it’s difficult to diagnose bronchiectasis in the plain film, unless they are very obvious.

    11. genchi bari italia says:

      …Sidereo professore, entrambi gli rx-torace, sono anormali.1° abbastanza facile per la presenza di una opacità nodulare, a limiti netti, con grosslane calcificazioni nel contesto, come da amartoma(dd con il condroma polmonarwe).2° , piu’ difficile, dimostra uno spostamento a sx , della linea paratracheale sx, con opacità triandolare sottostante, e che impronta la colonna d’aria tracheale.In quello zona ci sono linfonodi, nervi s strutture vascolari….non sappiamo che tipo di intervento chirurgico il paziente dovrà fare….se x processo maligno dovremo pensare ad una linfopatia…se benigno a patologia delle restanti strutture….venerdì la TAC ce lo dira’!

    12. mahwash says:

      pt1, hemartoma.
      pt2,straight back syndrome.

    13. gus says:

      ok i think patient 2 is normal. is a pre-op chest film but not for chest operation.

      • Jose Caceres says:

        Sorry, I never show normal films. It is a disrespectful.
        A different thing is showing an abnormality that may not be significant if properly interpreted.
        What do you think of the lineal density at the right base mentioned by Adela? What does it look like?

    14. JHC says:

      1. R paracardiac mass
      2. Intrathoracic rib

      • Jose Caceres says:

        Hurrah! You mentioned the right diagnosis.
        Apologies for not giving you credit in the official answer; was sent this afternoon.
        I will give here your well deserved recognition!

    15. Luigi Cocco says:

      Nel paziente 1 penso ci sia una cisti percardica., mentre nel paziente 2, davvero non trovo nulla!!!!

    16. yavuz says:

      1. hamartoma?
      2. scimitar sydrome.?

    17. Lo says:

      AV Malformation