Caceres’s Corner Case 50 (Update: Solution)

ESR_2012_Blog-CaceresCorner-590-CASE50

Dear Friends,

Muppet is so happy to have reached our 50th case, that he wants everybody to get the right answer. Here we have radiographs of a 52-year-old man with mild fever, blood-tinged sputum and left chest pain.

Diagnosis:

1. Carcinoma of the lung
2. Tuberculosis
3. Pulmonary embolism
4. None of the above


52-year-old man, PA chest

52-year-old man, PA chest

52-year-old man, lateral chest

52-year-old man, lateral chest

Click here for the answer to case #50

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    Jan 2013
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    DISCUSSION 19 Comments

    19 Responses to : Caceres’s Corner Case 50 (Update: Solution)

    1. javeria says:

      carcinoma of lung

    2. Bruno says:

      I think the left hilum is enlarged in the left with pleural effusion in this side. Could be lymphnodes or a mass. TB is an option but the age and signals in radiography make carcinome more probable in my opinion.

    3. genchi bari italia says:

      Potrei mai lasciare solo il “galactico” ?: ecco la mia risposta “ragionata” sulla clinica e sulla semeiotica radiologica. Vi è un ilo sx addensato e “tronco” verso il basso, con oligoemia distrettuale. Vi è una opacità “ovoidale” posteriormente a livello di T7-_T8, adagiata sulla pleura, con versamento basale. Vi è il dolore all’emitorace sx, con febbricola( da necrosi), vi è tosse striata di sangue( proveniente dal focolaio infartuale). Se i D-Dimeri, sono elevati….tutto quadra per EP, con i segni di Westembark ed Hampton hump .

    4. Albert says:

      Bilaterarel apical rude calcifications.
      Enlarged and dense bilateral hila. More obvius in the left where linear tracts and pseudonodular images extends towards the upper zone.
      Linear atelectasis in lingula.
      Left pleural effusion.
      Dense seudonodular image centered at the level of D7-8 on the lateral. not clearly visible on the PA bcause it may be hidden behind the left hila where an abnormal countour could correspond to it.
      Colecystectomy clips.

      My hypothesis would be pulmonary neoplasm in the upper segment of the left inferior lobe with bilateral hilar adenopathies. Anyway, with TBC sequelae in both pleural apex and left uuper lobe.

    5. Dr Strangelove says:

      Muppet is tricky !
      Round atelectasis

    6. jawad says:

      carcinoma of lungs

    7. Bruno says:

      Round atelectasis is a good possibility. But there`s an round opacity in left hilum. TB associated with round atelectasis?

    8. Alice says:

      linear opacities in the lul paramediastinal with luftsichelsign around aortic knob
      ovoid opacity on the left not very dense – possibly pleural??
      basal pleural effusion on the left

      i would do a ct, its suspicious for carcinoma.

    9. Xose says:

      Congratulations.
      I believe Muppet is not tricky this time. True answer is C.
      The peripheral opacity in the LLL and the pleural effusion as well as the clinical data, strongly suggest pulmonary embolism. The left lung also contains some chronic lesions e.g.: parenchymal bands and UL fibrotic tracts, which could be due to remote tuberculosis.
      Anyway, what happened yesterday to the FC Barcelona?

      • Jose Caceres says:

        Sorry, description is fine, but final diagnosis is wrong. Muppet tricked you!
        FC Barcelona had a bad day. It happens to the best of us. Even to Muppet.

    10. genchi bari says:

      Gli ANCA come sono?

    11. vijay kumar says:

      looks to be tuberculosis…

    12. Dr Strangelove says:

      I said Muppet is tricky because of the alarming symptoms. Well, may be there is here a lesson Muppet wants we to learn: we should trust radiological signs when they are clear and coherent. Nice case !
      PD: Before posting the answer I googled “round atelectasis hemoptysis” and quickly I got several cases.

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