Caceres’ Corner Case 93 (Update: Solution)

ESR_2012_Blog-CaceresCorner-590-CASE93

Dear Friends,

Presenting the case of a 85-year-old woman admitted with a severe urinary infection secondary to renal stones. Chest radiographs were taken one week after admission. Do you see any abnormalities in the chest?

Check the images below, leave your thoughts and diagnosis in the comments section and come back on Friday for the answer.


PA chest

lateral chest

Click here for the answer to case #93

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    19
    May 2014
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    DISCUSSION 29 Comments

    29 Responses to : Caceres’ Corner Case 93 (Update: Solution)

    1. Hiatal hernia.
      Hidropericardium.
      Pigtail in pulmonary trunk, Pulmonary embolism?

    2. Mirzada Irshad says:

      Scoliosis and air fluid level retrocardi

    3. gus says:

      1 Intrathoracic kidney
      2 iatrogenic diaphragmatic rupture

    4. Anna says:

      Hiatal hernia,…but it’ s obvious.I don’t believe that here is nothing else pathological:)

    5. ppippinn says:

      Hiatal hernia.

      What’s with the right bronchus?

    6. genchi bari italia says:

      …”galactico”…ragioniamo con la clinica…..calcoli renali e grave infezione…..il calcolo ostruente può aver determinato idronefrosi, “complicata” con pionefrosi….necessità di drenaggio esterno del pus tramite nefrostomia percutanea…..ma il catetere , mal posizionato, “migra” nel torace(si proietta contro l’ombra cardiaca!)….vi è inoltre un livello idroaereo che può corrispondere ad una ernia iatale da scivolamento gastrico….NB il Bari è nei play-off x la serie A….ai “blaugrana” gli auguri di tornare i grandi di sempre!

      • genchi bari italia says:

        ….gentilissimo professore non pensi che la mia prima diagnosi fosse esatta? …parlavo di un cattivo posizionamento del catetere di drenaGGIO per la idro-pionefrosi, pensando solamente che il catetere fosse stato posizionato PER VIA trascutanea, pielostomica e non ascendente….la mia intuizione diagnostica era esatta….anche se il Bari domenica ha perso il Bari come il Barca sono grandi!!!!!

    7. Branka says:

      It seems like hiatal hernia….

    8. essam says:

      ? sliding hiatus hernia with gastric fundus fluid level

    9. MARWIN says:

      iatrogenic diaphragmatic rupture vs diaphragmatic hernia with intrathoracic kidney

    10. gus says:

      Where is the other end of catheter?

    11. francesco says:

      trans-diafragmatic erniation of hollow viscus (hiatal hernia?); pig-tail catether in inferior vena cava, right atrium, right ventriculum, pulmonary trunk (for pneumoangiography).

    12. Iulia says:

      Mediastinitis?

    13. genchi italia bari says:

      …la chiave di lettura è il catetere( che non deve più essere in relazione alla pielostomia percutanea, come suggerito dalla clinica: calcolosi renale ed IVU)….allora il catetere è “vascolare” e si localizza in una sede “aneurismatica” cardio-vascolare, come si vede in LL…..a parte l’ernia iatale da scivolamento gastrico….qualche notizia anamnestica in più avrebbe agevolato la diagnosi….va meglio ora?

    14. gus says:

      I think there is a posterior cardiac displacement, maybe the catheter is not incidental there. the other job is to drainage collections but a pericardial fluid collection with cardioparacentisis is subxiphoid approach or percardiocentesis via pleural space. that’s why i want to know the other end of the catheter 🙂

    15. Mahmoud Elrai says:

      soft tissue located anterior to cardiac shadow likely intra thoracic kidney congenitally located with renal stone treated by DJ stent to release obstruction ,, hiatus hernia / inflammatory process located posterior to kidney shadow

    16. Laurens says:

      Very interesting case. There are many propositions for explaining the catheter – normal position of pulmonary catheter, percutaneous drainage catheter,inrathoracic kidney etc.
      I will add a possibility of a double J ureteral stent displacement through vena cava inferior and into the heart.
      Hiatal hernia is also seen.

    17. gus says:

      good case!!! I didn’t know that. It’s an urgent condition.

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