Caceres’s Corner Case 52 (Update: Solution)

ESR_2012_Blog-CaceresCorner-590-CASE52

Dear Friends,

Showing radiographs of a 42-year-old woman with high fever.

Diagnosis:

1. Carcinoma of the lung
2. Pulmonary abscess
3. Loculated empyema
4. None of the above

42-year-old woman, PA chest

42-year-old woman, PA chest

42-year-old woman, lateral chest

42-year-old woman, lateral chest

Click here for the answer to case #52

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    DISCUSSION 41 Comments

    41 Responses to : Caceres’s Corner Case 52 (Update: Solution)

    1. Marketa Mala says:

      pulmonary absces

    2. Probably a loculated pleural empyema due to the wall abnormalities and dislocation of the parenchyma seen on the lateral projection

    3. Dr Hesham says:

      pulmonary ab

    4. Giuseppe D. Palladino says:

      I think about a loculated empyema; I see the pleural sheets around it.

    5. sabina says:

      lobulated empyema

    6. MANOLIS SOTIRAKIS says:

      There is a cyst with a thick wall and a fluid level.
      The Rx findings with the high fever are elements for pulmonary abscess.

    7. ana maria says:

      pulmonary abscess

    8. Peter Pan says:

      pulmonary abscess

    9. anis697 says:

      loculated empyema

    10. Shahid says:

      Loculated Empyema

    11. tamar says:

      Pulmonary abscess

    12. JD Sierra says:

      Loculated empyema

    13. maria says:

      Pulmonary abscess

    14. Minnie Mouse says:

      Carcinoma of the lung, cause asymmetric thicking wall.

    15. genchi bari italia says:

      Polmonite necrotizzante.

    16. genchi bari italia says:

      Lesioni intrapolomonare con parete spessa, irregolare e bernoccoluta , superiormente. Non visibili adenopatie ilari. Un poò stirato verso l’alto l’ilo dx e la piccola scissura interlobare.Polomonite necrotizzante. Illustre professore ma non erano finiti con il caso 49, i livelli idro-aerei?

    17. Dr. Chalo (Argentina) says:

      Pulmonary abscess

    18. Alice says:

      I think it Is a pulmonary lesion, either simply an abscess or (more likely as mentioned by Minnie above) a carcinoma due to the nodular upper lateral wall.

    19. Xose says:

      Different sizes of the lesion in PA and lateral views, but it seems a pulmonary one. The wall is rough where we can see.
      It must be a superinfected carcinoma.
      Correct answer 1.

    20. Vilma says:

      Loculated empyema

    21. Vilma says:

      3. Loculated empyema

    22. Ricardo Macareno says:

      Hydropneumothorax can be a good option. The upper liquid level has a horizontal (in empyema usually concave), extending from side to side of the thoracic cavity as both lateral projection PA.

    23. Free Doc says:

      I think it is an abscess in a lung cancer and a air-liquid level. It has an irregular thicked wall in the upper side.

    24. Ricardo Macareno says:

      Pulmonary abscess.

    25. Dr Strangelove says:

      In addition to the asymmetric wall thickening pointed out by Minnie M, two more signs:
      – there is some volume loss of the RUL.
      – the minor fissure makes a Golden S sign (lateral view).

    26. Genchi says:

      Io penso , alla luce delle osservazione di alcuni miei colleghi e dello slittamento verso l’alto della piccola scissura interlolobare e dell’ilo che un cancro-ascesso non può essere escluso. Tuttavia la giovane età della paziente mi ha fatto propendere x una polomonite necrotizzante.Risulta evidente che la non responsività al trattamento antibiotico nei radiogrammi successivi, deve propendere x un cancro-ascesso.

    27. Badr says:

      we are dealing with cavitary lung lesion in the posterior segment of the Rt upper lobe with irregular thick wall and irregular inner margin, no hilar or mediatinal lymph nodes enlargement. so,it is less likely to be carcinoma, with clinical history, and location, most likely post primary TB.

    28. Ashraf Abohadeed says:

      Chest radiographs revealed a well defined right UL cavitary lesion. , thick walled , irregular inner margin , with air fluid level that is nearly of equal diameters in both views . Also homogenous opacity is seen Laterala to the cavity in frontal view , the right transverse fissure is bulging downwards, the there is no hilar lymph adenopathy .
      No pleural effusion seen.
      Normal rest of both lungs .
      differential diagnoss .
      Lung abscess on top of necrotising pneumonia in view of fever .

    29. Miguel says:

      Lung carcinoma, the Golden “S” sign is visible not only in the lateral view, but also in PA, and the thicknesss of the wall, I think it’s an infected lung carcinoma

    30. Dr Strangelove says:

      More interesting signs:
      – posterior wall of intermediate bronchus is thickened.
      – there is an opacity at inferior hilar window (doughnut sign) (lateral view)

    31. Ahwon(S.Korea) says:

      Hi. I’m a medical student. I had an exam last week and there was one question with a chest x-ray image showing a cavity with an air-fluid level. I had no doubt that it was “lung abscess” but I was wrong. Here I see your post, and now I understand it could be also lung cancer. It was very informative. Thank you.

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