Caceres’ Corner: Case No. 29 (Update: Solution)

Dear Friends,

During August, Muppet would like to discuss some basic principles of interpretation. The first case is a 46-year-old male with neurofibromatosis and bullous emphysema, who presents with fever.


1. Hidroneumothorax
2. Infected bulla
3. Lung abscess
4. None of the above

46-year-old man, PA chest

46-year-old man, PA chest

46-year-old man, lateral chest

46-year-old man, lateral chest

Click here for the answer to case #29

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    Aug 2012
    DISCUSSION 22 Comments

    22 Responses to : Caceres’ Corner: Case No. 29 (Update: Solution)

    1. Mm says:

      4. None of the above.
      I do not clearly see the anterior convexity of the 3rd rib in the right hemithorax, suggesting surgery, probably neurinoma surgery.
      I think it may be a pleural empyema

    2. Ulugh Bik KHAYRİ says:


    3. Gulci says:

      İnfected bulla

    4. RadLex says:

      There is a fluid collection arising from the pleura abutting the oblique fissure with an air-fluid level. Findings are suggestive of an empyema – ultrasound-guided percutaneous drainage of this collection is recommended.

    5. Fares says:

      Infected emphysematous bullae
      Pulmonary CT is recommended.

    6. Dr Hesham says:

      infected bulla on top of hydropneumotharx
      for me i would like to say that all of them could be in this case the hint in the lateral film

    7. SARBESH TIWARI says:


      • herbert kaufman says:


        Note that the fluid level is of different lengths in the PA and Lateral, placing the process in the pleural cavity rather than lung itself.


      La NF tipo 1 ha a livello polmonare alcune lesioni anatomo-patologiche che si compendiano come NF-DLD. Tra le varie lesioni sono comprese le cisti e le bolle: pertanto alla luce del reperto clinico( febbre di tipo non ascessuale) e radiologico( Cisti di cui una con livello idro-aereo) la diagnosi è di cisti infetta.RISPOSTA N 2. PS. il mio Bari ha iniziato il suo campionato , con una secca scofitta 4 ad 1! beati coloro che possono gioire con le grandi squadre!!!!

      • Jose Caceres says:

        Happy about Bari winning. Cannot comment about your choice. Still a few days until the final answer.

    9. melahat says:

      infected bulla

    10. GENCHI BARI ITALIA says:

      Le osservazioni di alcuni colleghi mi sembrano esatte: sembra che ci siano due livelli idro-aerei,una nel polmone da cisti infetta e l’altra nel cavo pleurico , con idro-pneumotorace, da rottura di un’altra bolle infetta , sub-pleurica, nel cavo pleurico.Mi scuso per la disattenzione.

    11. Deniz KIZILIRMAK says:

      infected neurofibromatosis bullae

    12. Alice says:

      Right hilum has moved upwards, right lung volume is reduced in comparison to the left side, right diaphragm is elevated.
      Pleural gas / fluid level dorsal, consistent with hydropneumothorax if the Patient underwent surgery recently (anterior portions of 2nd and 3rd right ribs appear missing).
      In case of fever empyema is a possibility i guess.
      Looking forward to the solution!!!