Caceres’ Corner Case 92 (Update: Solution)

ESR_2012_Blog-CaceresCorner-590-CASE92

Dear Friends,

Muppet wants to test your diagnostics skills with the following case of a 39-year-old smoker with dyspnea. Check the images below, leave your diagnosis in the comments, and come back on Friday for the answer.

Diagnosis:

1. Bronchogenic carcinoma
2. Endobronchial TB
3. Benign endobronchial tumour
4. None of the above


q1

q2

q3

q4

Click here for the answer to case #92

Be Sociable, Share!
    05
    May 2014
    POSTED BY
    POSTED IN
    DISCUSSION 29 Comments

    29 Responses to : Caceres’ Corner Case 92 (Update: Solution)

    1. gus says:

      on Rx partial – segmental opacity with out air bronchogram of the right upper lobe B2.no tracheal shifting. no juxtaphrenic peak . a small elevation of the minor fissure.
      on the ct we can see a small lost of volume of the right uper lung and a mass like lesion above the right hilum.

    2. genchi bari italia says:

      ….faccio pre-tattica….il goal al 90’…..

    3. NIyi says:

      plain film and Ct demonstrate uniform opacity of the right upper lobe.The right minor interlobar fissure is displaced upwards indicating right upper lobe atelectasis. CT shows that right upper lobe bronchus is filled with soft tisue opacities.There is mediastinal lymphadenopathy.

      Diagnosis: Bronchogenic carcinoma.

    4. Laurens says:

      I think that suspected mass like lesion on CT above right hilum is actually collapsed lung – upper right lobe atelectasis.
      Upper lobe atelectasis can also be seen on chest radiographs
      (triangular RUL homogenous opacity, cranial displacement of horizontal fissure).
      If I am correct I ask myself what are these hyperdense opacities inside the collapsed lung on last CT picture. If they are hyperdense vessels on non-enhanced scan could this be pulmonary embolism?

      • Jose Caceres says:

        Yes, you are right, the dense opacities are the clue to the diagnosis.

        • Laurens says:

          Poststenotic (resorptive) atelectasis due to mucoid impaction. Possible cause Allergic bronchopulmonary aspergillosis?

    5. gus says:

      melanoma? carcinoid?

    6. gaborini says:

      mucus plug? or maybe a mucus producing tumor?

    7. Mohammed says:

      Ca bronchus causing rt. upper lobe collapse.

    8. Anna says:

      Hi!
      I guess, it is a RUL atelectasis due to a benign endobronchial tumor. There is no malignant mass seen, no expancity, no lymph node involvement, RUL-bronchus is smoothly cuting off.
      I believe , I’ve seen the same appearance once in my practice : young woman with bronchial cut off.

    9. Fr.Sarabia says:

      Endobronchial benign tumor ? (Non expansive athelectasic and no bone infiltración)
      Hiperintensity it’s due to a mucus producing tumor ?
      So, “endobronchial benign neoplasm mucinoid ” ?
      (Sorry due to my poor english)

      • Jose Caceres says:

        Usually, with a lot of mucus you have a “mucinous bronchogram sign” in which the bronchi are less dense that the surrounding parenchyma. The case presented shows the opposite: high-density mucus. This sign is highly suspicious of allergic aspergillosis.

    10. Luigi Cocco says:

      Stenosi bronco superiore dx da K, con atelettasia lobare superiore ed enfisema secondario dei due lobi restanti.

    11. gus says:

      Last try – Mucoepidermoid carcinoma of lung?

    12. Tanveer says:

      lobectomy.

    13. gus says:

      Is not my round 🙂

    14. genchi bari italia says:

      ….complimenti “galactico”….il numero di risposte indica l’interesse suscitato da questo caso!…io penso, che la diagnosi esatta l’abbia proposta tu, quando tra le opzioni diagnostiche hai suggerito la TBC endobronchiale: le calcificazioni, alla TC senza mdc, possono corrispondere a granulomi di necrosi caseosa, calcificati, che a sede endobronchiale, hanno determinato la successiva atelettasia del lobo superiore…..alcune delle immagini adenopatiche sembrano avere le stesse calcificazioni….pensare ad una Aspergillosi(invasiva e/allergica) avrebbe dovuto sottendere un deficit immuninatario.e-o asma o fibrosi cistica, che non sono state riportate…..se ho sbagliato allora dico che anche i grandi , a volte piangono(il Barca di quest’anno)…..

    Leave a Reply

    Your email address will not be published. Required fields are marked *