Caceres’ Corner Case 96 (Update: Solution)

ESR_2012_Blog-CaceresCorner-590-CASE596

Dear Friends,

Muppet has insisted in presenting the following case: radiographs of a 48-year-old male with cognitive problems and episodes of amnesia. What do you see? What would be your diagnosis? Leave us your thoughts in the comments section and come back for the answer on Friday.


PA chest

lateral chest

Click here for the answer to case #96

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    Jun 2014
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    DISCUSSION 33 Comments

    33 Responses to : Caceres’ Corner Case 96 (Update: Solution)

    1. Karla says:

      Venous pulmonary hypertension and lingular atelectasis.

    2. Karla says:

      There seems to be a bulge in the left side of the heart, left atrial appendage maybe? It could be left atrial embolism causing ischemic strokes.

    3. Laurens says:

      Increased pulmonary flow with upper zone vascular prominence.
      Vessels visible to the periphery of the film. Heart size normal. Left atrial appendage prominent. This could indicate left to right shunt, possible ASD.

    4. Laurens says:

      More prominent blood flow on the left could mean pulmonary stenosis. I am thinking of other differentials.

      • Laurens says:

        I am adding a possibility of left basal bronchiectases causing plethora of the upper lobe vessels on the left.

    5. Laurens says:

      And Blalock-Taussig shunt.

    6. MASCAREL PATRICK says:

      pulmonic valvular stenosis with post sténotic dilatation

    7. gus says:

      Prominence of the pulmonary arch especially dilatation of the left pulmonary artery and increased of the pulmonary vasculature. PAH
      (left-to right-shunt)?

    8. Laurens says:

      Main question I am asking why is there more prominent pulmonary flow on the left than on the right. I will stay with my first suggestion of left to right shunt and say there is a possibility of patent ductus arteriosus ( in ASD we would have bilateral increase of blood flow, not unilateral). Other differential will stay pulmonary stenosis (possible jet effect).

    9. genchi bari italia says:

      ….stimatissimo Professore….il punto è spiegarsi l’iperafflusso “distrettuale” in campo polmonare superiore sx e la patologia cerebrale(primitiva o secondaria?)….Escluse le cause “classiche” di ridistribuzione del circolo(Scompenso cardiaco-enfisema polmonare) resterebbe l’embolismo…ma il territorio ipoperfuso, in questo caso il lobo inferiore, è normale( assenza segno di W.)….resta pertanto una causa locale…è chiaro che la diagnosi è fatta con angio-TC, ma possiamo ipotizzare un processo produttivo neoplastico(angiosarcoma) con successive metastasi cerebrali? Fantasia??? Tutti i grandi calciatori infatti sono ottimi fantasisti!!!Un abbraccio.

      • Jose Caceres says:

        Your theory is interesting, but is not the right diagnosis. Consider a pathologic process that may affect different organs.

        • genchi bari italia says:

          ….tromboembolia polmonare da Lupus Eritematoso Sistemico: da auto-anticorpi anti-fosfolipidi.Encefalite e tromboembolismo polmonare….ancora fantasia?

    10. gus says:

      Tuberous sclerosis?

      • Jose Caceres says:

        As far as I know, tuberous sclerosis gives disseminated interstitial changes.
        See the answer to Genchi Bari and go back to square one.

    11. genchi bari italia says:

      ….grande Barca….grande Bari( anche se restiamo in serie B!)….

    12. Laurens says:

      My shunt propositions ended in total failure.
      I was thinking of a new idea: it could be vasculitis,
      like Behçet’s disease.

    13. Marta says:

      Hi,
      As to the rule KISS – the most often seen cause of unilateral vascular lung anomaly is pulmonary embolism. This could go with the mental deterioration syptoms caused by multiple embolic infarcts.
      I am worrying about shape of the aorta on lateral view.. why it is so opaque at the arch/descending part? it is not contiguos but has “step”.. Could it be dissection pressing the left hilar structures – including the left pulm artery? and then – possible disscention and thrombosis in carotic artery – giving neurological symptoms?

      • Jose Caceres says:

        You are right about pulmonary embolism. But it is not the correct diagnosis in this case. Heart is normal and hila are not enlarged.
        This is an unusual disease. Answer tomorrow.

    14. gus says:

      Langerhans cell histiocytosis ?

    15. MASCAREL PATRICK says:

      SLEEP APNEA SYNDROME WITH PULMONARY HYPERTENSION

    16. For me is a lung and characteristics of enmphisema, athelectasias, loos of the pulmonar arc, because I think in a poor concentratión by oxigen. Too exist central hiperdensity and great posterior hiperdensity in the place of left appendege that is posterior, is posssible tha atrial chronic fibrilation and samall multiples infarcts in the brain

    17. Juana María Plasencia says:

      I´m according to Lauren. Could it be any vasculitis? Probably Behçet’s disease.

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