Caceres’ Corner Case 84 (Update: Solution)

ESR_2012_Blog-CaceresCorner-590-CASE84

Dear Friends,

Muppet and I are going to Mexico for a week. When back, we expect all of you to have clinched the diagnosis of this 58-year-old male with chest pain.

Leave your thoughts and diagnosis in the comments section below and come back on Friday for the answer.

Diagnosis:

1. Metastatic disease
2. Pulmonary infarct
3. Mesothelioma
4. None of the above


PA chest

lateral chest

Click here for the answer to case #84

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    Jan 2014
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    DISCUSSION 18 Comments

    18 Responses to : Caceres’ Corner Case 84 (Update: Solution)

    1. Rajni says:

      Metastasis

    2. Mila says:

      I can see some focal translucence in the ribs (posterior part of IV and IX in the left, anterior part of the II and VI in the right) and anterior Th11 body- that suggests osteolytic lesions and matastasis. In the PA and Lateral viev there two round external shadings- masses in the right lung/pleura?
      In lateral viev right posterior costo- phrenic angle is shallow- pleural adhesions? Little amount of fluid?
      I don`t know what are these lines in the hilum in the lateral viev- artifacts? feregin bodies?

    3. Luigi Cocco says:

      Mesotelioma benigno.

    4. Dominik says:

      – In right upper field and right midle field ther are round ill define lucencies. They are confirm on the lateral view, where one of them is adjacent to posterior part of the chest wall. Its look more metastatic becouse of sharp adjacent angle.
      – Bilateral lungs have signs reticular luciencies, perhaps becouse of fibrotic changes; perhaps he is a long time smoker
      – there is a billateral define cephalisation of vesels
      – the heart looks mild enlarge more with the left ventricle
      – on the lateral view is also seen the shallow posterior costofrenic angle – effusion?
      – osteopenia
      – degenrative changes of the endplates of vertebral th bodies
      – anterion arch of right VIII rib is discontinuous – osteolityc leasion ?
      – discontinous shadow of sternal end of left clavicula – lityc leasion?

      I ll recomend to read clinical history contact the phisician of this patient and after that dicede to CT scan of thorax and eventualy scintagraphy to localise bone metastais.

    5. sameh khodair says:

      these osteolytic lesions in the medial border of the right scapula, the left clavicle and left upper ribs appears to be bone resorption rather than destruction ( brown tumor ), I seen also posterior mediastinal smooth well define lesion opacity, so I think about parathyroid cyst associated with hyperparathyroidism

    6. genchi bari italia says:

      ….stimatissimo professore….vi è una frattura patologica scomposta al 3° interno della clavicola sx, nonché riassorbimento, osteolitico, dell’arco posteriore della 4 costa sx; altre alterazioni costali, di tipo addensanti, a carico della 5 di sx e della 5 e 6 costa dx.Vi è poi una opacità , di tipo extra-pleurico, a livello del soma di D5-D6 di dx….ispessimento della pleura posteriore dx con obliterazione del seno vertebro-somatico… non mi piacciomo i somi vertebrali di D7-D8-D9 ……tutto questo deporrebbe per malattia metastatica.

      • Jose Caceres says:

        Any alternative?

        • genchi bari italia says:

          ….quello che sin dall’inizio non mi ha convinto è la “coesisenza” di lesioni litiche e lesioni addensanti ossee costali….quale è il valore della fosfatasi alcalina nel siero e quello della idrossiprolina nelle urine?l’anamnesi è muta?

          • genchi bari italia says:

            ….mitico…. “l’alternativa” ad una disseminazione metastatica ossea, può essere , per spiegarci l’interessamento “poliostotico”, è quello di una malattia “ematologica” maligna: leucemia, linfoma, mieloma “multiplo”…con cointeressamento della pleura….Grazie Professore!

    7. CLAUDIA says:

      METASTATIC DISEASE

    8. gus says:

      on the frontal view we can see osteolytic destruction of the 3-5 rib on the left and pathologic fracture of the left clavicle with thoracic wall opacity.
      opacity’s also is sub right scapula and above the right hilum.
      also we can see a reticulonodular pattern of the lungs.

      on the lateral view we can see well the pleural effusion on the right and the two opacity’s(as pleural thickening (plaques?)) one sub sternal and the other posterior paraspinal.
      i can’t see hilum lymphy nodes. i can’t see calcifications on the pleural masses or on the diaphragm (asbestos exposure).
      there is not shift of the mediastinum (but we have a small pleural effusion)
      definatly we need CT!!!
      i can’t exclude mesothelioma but my first thought is metastasis.

    9. András says:

      I think it is going to mesothelioma. I see the coin lesion on the right, the rib destruction of the 4th left rib, and a veil-like opacity over the left apex (pleural plaqing?).

    10. Dylan says:

      CXR (PA and Lateral):
      1. multiple lytic rib and Lt clavicular lesions (destructive).
      2. at least a rounded mass in the right missile zone, overlying the inferior Rt scapular angle.
      3. Reticulonodular changes bilaterally on the frontal projection.
      4. Blunting of the posterior Rt Costo-phrenic angles on the lateral view (pleural effusion).

      Impression: metastatic disease.

    11. Ferreiriño says:

      1. Metastatic disease

    12. Veronika says:

      None of the above

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