Caceres’ Corner: Case No. 44 (Update: Solution)

Dear friends,

Muppet is in Chicago at the RSNA meeting. While looking for Miss Piggy, he found time to discover the following case: 65-year-old female asymptomatic.

Do you think the chest is normal? If not, then where is the abnormality?

Click here for the answer to Case 44

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    DISCUSSION 25 Comments

    25 Responses to : Caceres’ Corner: Case No. 44 (Update: Solution)

    1. dr_D says:

      Thoracic kyphoscoliosis?Broncholithiasis.Marked small pleura interlobaris dex.Cardiomegaly.Arteriosclerosis aortae.Low position of the fornix of the stomach-may be because of a process under the left diaphragm….

    2. Genchi Bari Italia says:

      No, il torace non è normale: esiste una opacità a livello mediastinico, al di sopra della carena tracheale a sx che impronta il bronco principale di sx.”While , mister Caceres looking Miss Piggy”, qui a Bari scopriremo cosa è!!!A presto.

    3. Dr Strangelove says:

      subtle opacity in anterior segment RUL with air bronchogram (may be ground-glass at CT). In case this is not an acute condition, bronchoalveolar carcinoma should be ruled out.

    4. MANOLIS says:

      There is a dislocation of the paraoesophageal line on the left.

    5. Kelvin says:

      Looks normal to me, bar the minor scoliosis.

      • Jose Caceres says:

        It ain’t normal. Look carefully

        • Kelvin says:

          The only thing I noted was prominent pulmonary vasculature…but in clinical practice it is quite probable that I would have reported this as normal!

          I was also seeing a subtle nodular opacity just lateral to the left hilar point – which I am attributing to a superimposition.

          I still blame it on Ms. Piggy!!

    6. Genchi Bari Italia says:

      Perchè è stata proposta per “prima” la L.L. del torace? : è a livello della finestra aortico-polmonare la chiave di lettura? Ho 2 idee al proposito: è chiaro comunque che la TC fa la diagnosi.Il professore ha trovato Miss Piggy ?

      • Jose Caceres says:

        Perché la L.L del torace? Because nobody look at it and can be very helpful.
        Found Miss P. and had a wonderful time.

    7. Carlo says:

      Abnormal. There is an opacity on left side of trachea near biforcation, (as Dr genchi says) in the area of aorto-pulmonary window and an irregular contour (lobulated) of azigos-esofageal stripe. So it should be an adenpathy.

    8. Dr. Waleed LIBYA says:

      This my first comment, however, I’m a big fan to Caceres’ corner as well as Dr. Pepe’s casebook.
      Frontal: there is a small rounded density overlying the ascending aorta.
      Lateral: barely seen mass in the anterior clear space (anterior mediastinum), so my impression is thymoma and better to be evaluated by CT.

    9. Xose says:

      Abnormal.
      Although there is a scoliosis, the right edge of the mediastinum seems empty. On the left there are two abnormal structures over the aortic knob and the aorto-pulmonary window.
      The description is rather inexact but I think it could be a persistent left superior vena cava.
      We are expectant about Muppet and Miss Piggy.

      • Jose Caceres says:

        Muppet is a gentleman and would not comment about a lady.
        Would suggest that you look at previous blog cases. Answer may be there.

        • Xose says:

          Thank you.
          There is an anterior mediastinum mass. Tymoma?

          • Jose Caceres says:

            See? It is not difficult if we know were to look. And the anterior clear space if one place to investigate, always.

        • Dr Strangelove says:

          I first considered the subtle retrosternal opacity as pulmonary. Now it seems it should be located in the anterior mediastinum, and the opacity noted by Bari, superimposed to the aortic knob must be a focal widening of the anterior mediastinal line.

    10. Genchi Bari Italia says:

      La LL del torace non è perfetta perche, leggermente ruotata , per cui si vedono archi costali. Comunque l’opacità in paratracheale sx , potrebbe avere sede retrosternale ed allora la diagnosi più probabile, ricordando la legge dele 4 T per il mediastino anteriore, potrebbe essere un timoma asintomatico

    11. RadLex says:

      The anterior compartment of the mediastinum is not homogenously radiolucent. Could this be a thymoma or thymolipoma?

    12. froso says:

      Combination of PA and lateral Xray shows an anterior mediastinal mass + In the lateral Xray there is a linear structure from the left hilum to the mass.
      This is probably a vessel (feeding vessel).
      Although not in a typical location, this should be a extrapulmonary sequestration, with the feeding vessel arising propably from the left pulmonary artery.

    13. froso says:

      Combination of PA and lateral Xray shows an anterior mediastinal mass + In the lateral Xray there is a linear structure from the left hilum to the mass.
      This is probably a vessel (feeding vessel).
      Although not in a typical location, this should be a extrapulmonary sequestration, with the feeding vessel arising propably from the left pulmonary artery.
      (correction: extralobar sequestration)

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