Caceres’ Corner Case 98 (Update: Solution)

ESR_2012_Blog-CaceresCorner-590-CASE598
Dear Friends,

With your welfare in mind, Muppet has selected this week’s case. Radiographs belong to a 76-year-old woman, admitted to the hospital with moderate fever and vomiting.

Diagnosis:

1. Aspiration pneumonia
2. Tracheomegaly and pneumonia
3. Pneumonia and pericarditis
4. None of the above


PA chest

Lateral chest

Click here for the answer to case #98

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    Sep 2014
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    DISCUSSION 23 Comments

    23 Responses to : Caceres’ Corner Case 98 (Update: Solution)

    1. Ricardo W says:

      Me parece que neumonía y pericarditis es la correcta. Saludos desde Chile

    2. Gerasimos says:

      Aspiration pneumonia

    3. gaborini says:

      Any previous surgery? Does the patient have a pull-up stomach?

    4. Adam says:

      Achalasia and aspiration pneumonia

    5. Jonathan says:

      Dilated esophagus for sure with probable aspiration pneumonia. Given age, I would guess pseudoachalasia from gastroesophageal adenocarcinoma. I would move onto CT first to look for possible fistulous connection between esophagus and airway/lung.
      JC

    6. Budimir says:

      mediastinitis?

    7. Dr Ramesh K Pandey says:

      Greetings sir…
      Looks like Aspiration pneumonia …

    8. András székely says:

      RLL pneumonia

    9. Francisco says:

      Neumonía lóbulo medio

    10. Andrei says:

      Condenstation of the RML, clinicaly it might be an aspiration pneumonia of the middle lobe. Decending toracic aorta on the lateral view is shifted post. idicating a mass located retrocardiac, it can be an enlarged distal oesofagus or an atipical pericarditis as you can observe almoust entire cardiac siluete on the lateral view. I vote for option no 3. An Iopamiro enema with would help in case of a oesofagus bronchai fistula.

      • Jose Caceres says:

        Did you notice the right side of the heart is more opaque then the left on the PA? This would be unusual in pericarditis

        • Andrei says:

          There is clearly something retrocardiac that is pushing the decending toracic aorta posterior. I agree with genchi, it might be a leiomioma of the oesofagus. Fever can be explained by the pneumonia, but the vomitig must be from a longer time if there is a leiomioma, as they tend to grow slow.

    11. genchi bari italia says:

      …”pseudo-cancellazione” del disegno vascolare polmonare, in PA,a livello della silhouette cardiaca di dx, da parte di una opacità, fusiforme, densa ed omogenea che sembra connettersi con l’esofago superiormente leggermente ectasico…potrebbe trattarsi di un leiomioma esofageo…

    12. Eric says:

      I think Jonathan may be right. The esophagus appears dilated, suggestive of achalasia, but it’s only the prox esophagus. The patient appears to have either a middle mediastinum mass with posterior extension, or posterior mediastinal mass with anterior extension. Overall, I’d say a mediastinal mass with mass effect on the distal esophagus – may be an esophageal cancer, but also could be an mass extrinsic to the GI Tract.

    13. gus says:

      i see the opacity on the right cardiac side (silhouette sign )ok
      On the lateral view i think there is posterior dispacement and widening of right main bronchus. maybe a fistula?

    14. genchi bari italia says:

      ….e se fosse un aneurisma fusiforme dell’aorta discendente ?

    15. mod says:

      Aspiration pneumonia

    16. Adam says:

      Enlarged esophagus due to Esophageal cancer and fistulas made with the right lung,which causes pneumonia with fever and vomiting.

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