Caceres’ Corner Case 48 (Update: Solution)

Dear friends,

to celebrate the coming year Muppet wants to finish the chapter of air-fluid levels by showing you two patients with fever and malaise.

The question is: where is the fluid located?

1. A in a pleural cavity and B in a lung cavity
2. B in a pleural cavity and A in a lung cavity
3. Both in a lung cavity
4. Both in a pleural cavity


Click here for the answer to Case 48

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    Dec 2012
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    9 Responses to : Caceres’ Corner Case 48 (Update: Solution)

    1. Genchi Bari Italia says:

      Bella lezione di semeiotica radiologica classica del Professore che ringrazio.I criteri per stabilirne la sede sono tre( in AP e LL).Sede della lesione, margini della lesione ed angoli di raccordo con la parete toracica. In A : la sede( in LL) è mediana;i margini( in LL ), sono indistinti e gli angoli di raccordo non sono ben valutabili. In B , la lesione è periferica, i margini sono distinti, la sua morfologia è simile in AP e LL ed ,infine gli angoli di raccodo sono ottusi( segno della gravidanza).Pertanto se il mio ragionamento è esatto, la risposta corretta è 2.

    2. Katerina says:

      Happy new year to the Muppet and to you professor !!! Hope you will continue to intrigue us with your exciting cases in 2013 and in the years to come !!! Personnaly, I think that I have learned a lot from your lectures and your cases during last year so I will give it a try with these cases.

      In the first case there is an air-fluid level in a cavity with indistinct margins in the AP projection especially in its upper part(incomplete border sign) and distinct borbers in the lateral projection, which indicate a loculated pleural effusion with an air-fluid level. Moreover, the diameter of the air-fluid level is smaller in the lateral than in the AP projection (oval shape) and the angles with the thoracic wall are obtuse, suggesting that the cavity is situated in the pleura in the anterior thoracic wall (extending maybe in the anterior mediastinum).

      In the second case the air-fluid level is located in a cavity with distinct borders in both projections which abuts the posterior thoraric wall and the right major fissure in the lateral projection. There is a negative silhouette sign with the right hemidiaphragm in the AP projection. The diameter of the air-fluid level is the same in both projections (round shape). Despite, the obtuse angle of the lesion with the thoracic wall(in the lateral projection), I think that all indications suggest that it is located in the RLL.

      So the right answer is 1 (A. in a pleural cavity and B. in a lung cavity).

      I hope I didn’t disappointed you and the Muppet. I tried my best !!

    3. Jose Caceres says:

      Muppet wants to give a hand: so far, nobody has made the correct diagnosis.

    4. genchi bari italia says:

      La morfologia del livello idro-aereo, nelle 2 proiezioni rx è diversa a seconda che essa sia in una cavità acquisita(intrapolmonare) o preesistente ( extrapolmonare).Nel 1° caso essa si comporta come un palloncino elastico che riempiamo di liquido: allora avrà una morfologia e volumetria “identica” nei 3 piani dello spazio.In B si osserva questa condizione ed il livello è intrapolmonare( cisti infetta?). In A la morfolofgia e volumetria è differente nelle 2 proiezioni e nulla sembra limitare la parte gassosa cranialmente, per cui dovrebbe essere extra-polmonare….ma in LL sembra osservarsi una opacità triangoliforme con apice all’ilo, come da atelettasia e pertanto di natura non liquida.Pntorace con atelettasia inziale del lobo polmonare superiore( falso livello idroaereo).

    5. genchi italia says:

      quale è la soluzione finale del caso 48?

    6. Dr baqi says:

      I think 3 both are in the lung cavity
      Thanks

    7. nana says:

      both are loculated pleural effusion

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