Caceres’ Corner: Case No.13 (Update Solution)

Dear Friends,

Muppet is very happy with your progress. But, given his mean disposition, he wants to test you with this case:

Forty-year-old woman with a moderate cough.


1. Tuberculosis
2. Vascular malformation
3. Aspergillosis
4. None of the above

40-year-old woman, PA chest

40-year-old woman, PA chest

40-year-old woman, lateral chest

40-year-old woman, lateral chest

Click here for the answer to case #13

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    Feb 2012
    DISCUSSION 30 Comments

    30 Responses to : Caceres’ Corner: Case No.13 (Update Solution)

    1. Albert says:

      -Young woman with unspecific clinical presentation.
      -The first thing I notice is a complex combination of nodular and tubular images on the left upper lobe (I would prefer it in lower lobes thinking in a pulmonary AVM, diagnosis which must guide us to rule out Rendu Osler Webber from my point of view).
      – In a second view I think I can detect the underlying parenchyma is not normal, it seems like with fibrous thick tracts; the first diagnosis which come to my head now is ancient tuberculosis (previous granulomatous infection). I really like the upper location for TBC.

      Trying to correlate the finding I described; my first option is a kind of vascular malformation secondary to previous inflammatory process (probably TBC). So a kind of COMPLEX RASMUSSEN ANEURYSM.

      The second possibility is that I have invented the fibrotic parenchymal changes and that it was “only” a AVM (need in this case to rule out Rendu Osler Webber as I said before).

    2. Ahmad khan says:

      i’ll go with option 1 i.e tuberculosis

    3. girish kulkarni says:

      -Mild volume loss involving left upper lobe with cavitatory lesions,fibrotic,nodular and tubular opacities.

      -Suggestion of narrowing of distal left main bronchus.

      Aspergillosis on the background of chronic tuberculosis should be considered. few of the soft tissue opacities may represent rasmussen aneurysms.

      • Jose Caceres says:

        Left hilum is not pulled up. Don’t you think this goes against chronic TB?

        • girish kulkarni says:

          yes sir but there is definite volume loss. linear fibrotic strands also are seen.process is too focal for vasculitis(although bronchial wall narrowing has been described in WG) Otherwise it could be ABPA.

    4. Nikhil says:

      Aspergillosis with ?h/o TB from the nodular shadows.

    5. Susan says:

      Why do I miss the shadow of the richt breast?
      Should we think about immunsupression as a result of chemotherapy due to breast cancer? Then an reactivatet, but not really typical tbc is also possible as an aspergilloma …

    6. Susan says:

      Sorry, “right” breast, of course 🙂 …

    7. Susan says:

      Why do I miss the shadow of the right breast? Should we think about immunosuppression in consequence to chemotherapy due to breast cancer? Then a not really typical tbc is also possible as an aspergilloma …

    8. Adela Montelongo Martín says:


    9. Marius says:

      Extensive bronchocele in left upper lobe with reduced interstitial makings. Pectus excavatus.
      Cause: ABPA? Atresia of culmen bronchia with collateral air drift?

    10. Black Pete says:

      Hyperlucency of left UL (apicoposterior) with nodular/tubular structures – segmental bronchial artresia with Air-trapping and mucoid impaction?

    11. Matteo says:

      Vascular malformation. Probably anomalous return of the polmunary vein of the left upper lobe.

    12. aca says:

      I see apicoposterior hyperlucent upper lobe,with fibrotic changes in a border of it…there is a one central positioned round calcification within it,which possibly be a tuberculoma…dilatated vascular structures locoregional is a probably due tu fibrotic changes which surround them…cut off left hila indicated fibrosis or compression…i vote for old drainaged abscessus,aspergiloma 🙂

    13. Vilma says:

      Vascular malformation.

    14. sultan says:

      There is hyperlucency with minimal atelectatic changes as well as prominent vascular markings in the left upper zone, I think it is sort of vascular malformation.

    15. sabra says:

      4. Bronchial atresia

      • Jose Caceres says:

        Correct. It is a matter of putting together the information that the radiograph offers.
        Muppet happy!

    16. the dark side of radiology says:

      We already knew it! In fact, it is very prevalent in our planet, Tatooine…

      Sent from my i-Millenium Falcon

      • Jose Caceres says:

        Muppet belongs to a different generation and honors Admiral Adama.
        And Sheldon.

    17. Vincenzo Genchi, city Bari, Italy says:

      Broncoceli da Atresia di un bronco con iperventialzione del territorio polmonare corrispondente ( air-trapping ) attraverso i canali di Kohn.

    18. Josue says:


    19. laura says:

      ABPA or bronchial atresia

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