Caceres’s Corner Case 55 (Update: Solution)


Dear friends,

Showing images of a 30-year-old male, asymptomatic. What would be your diagnosis?

1. Pericardial cyst
2. Lung tumour
3. TB lymph nodes
4. None of the above

30-year-old male, PA chest

30-year-old male, PA chest

30-year-old male, lateral chest

30-year-old male, lateral chest



Click here for the answer to case #55

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    Feb 2013
    DISCUSSION 20 Comments

    20 Responses to : Caceres’s Corner Case 55 (Update: Solution)

    1. Rasul says:

      Pericardial cyst

    2. Maria says:

      Nothing of the above!

    3. Miguel says:

      In the PA-Chest there is a retrocardiac nodular image, with well defined borders, which leads me to think it’s an extrapulmonary lesion.
      At the CT, the nodular lesion has a soft tissue density, with well defined borders, and doesn’t appear to be disrupting the surrounding lung parenchyma.
      With all this, I’m inclined to think this is a mediastinal lesion, in contact with the heart, an so a Pericardial Cyst would be my choice.

    4. free doc says:

      CR shows a round well-defined mass in the left side, over the heart. In CT there is a extrapulmonary mass in contact with the heart, with soft tissue atenuation, although in enhanced CT pericardium shows an atenuation higher than mass does. I think it is a percardial cyst

    5. hatem says:

      I think it is a vascular lesion ?? aneurysm of the ?? coronary artery

      • Jose Caceres says:

        Considering that IV contrast has been injected, I would expect a vascular lesion to enhance.

    6. hatem says:

      vascular lesion

    7. fuldem says:

      pericardial cyst

    8. Ricardo Macareno says:

      An important point in the evaluation of this lesion is the absence of pericardial effusion.
      It could be a fibroma?

    9. Albert says:

      I cant see the x ray images. I think we are in front of a pericardial lesion. It doesnt look like a simple cyst, so I would exclude the pericardial cyst. The most frequent pericardial solid lesion would be metastasic disease, the age of the patient goes against this diagnosis. The same happens with the lack of pericardial effusion, does not favour the malignant ethiology. With this I would think of a benign mesenchymal primary pericardial tumor (hemangioma, lymphangioma, lipoma, neural tumor, leiomioma). No fat density and no significant enhancement goes against lipoma and hemangioma respectively. I would hope a slightly dense and homogeneous soft tissue mass for a leiomioma. It has no calcium and the enhancement if exists seems to be minimum.
      I have never seen one, but my orientation would be a PERICARDIAL LYMPHANGIOMA.
      Anyway, comparision with prior Xray and further strict follow up is necesseary.

    10. Alice says:

      Soft tissue mass in left lower lobe adjacent to or invading the pericardium, possibly of mediastinal origin.
      It is somewhat ill-defined, while the surrounding lung parenchyma seems normal.
      The mass is rather homogeneous without calcifications or cystic
      Even though the lung looks normal and there are arguments for mediastinal origin it could very well be an early stage lung tumour. I am not convinced we can reliably differentiate between the above mentioned options with imaging alone.
      Biopsy or surgery is mandatory (unless there are older images to prove it is a stable lesion).

    11. genchi bari italia says:

      Vi sono due tubicini (?) rxopachi a livello della sesta costa, bilateralmente.Vi è una immagine ipodensa, che non prende CE ed appare indissolubile dalla parete cardiaca. Se il soggetto ha subito un intervento chirurgico, questo puo’ essere la risposta infiammatoria localizzata,come nela Sindrome post-pericardiotomia.La risposta alla terapia cortisonica ne è la controprova.

    12. Prasanna Kulkarni says:

      My answer is D.

      On the frontal view, there is evidence of a well circumscribed ovoid mass projecting over the retrocardiac region in the left lower zone. on lateral view, the mass appears to be in the region of middle mediastinum.

      On CT scan, the mass appears to be intrapulmonary. bronchioles and pumonary vessels are seen at the periphery of the mass. the contact between the mass and the pericardium is ill defined, without any visible fat planes.the internal attenuation of the mass is slightly less than of the interventricular septum, indicating enhancement. no evidence of calcification or macroscopic fat.

      Correlating with the age and absence of symptoms, my differentials would include peripheral carcinoid, intrapulmonary sequesteration and round atelectasis.

      • Jose Caceres says:

        Good! At last someone has seen the light!

      • Dr Strangelove says:

        I like your diagnosis of peripheral carcinoid (there is a distorted bronchus at the periphery of the mass). A dense bronchogenic cyst is less likely. Definitely it is NOT an extrapulmonary mass.

    13. genchi bari italia says:

      CCAM , Tipo 3 sec. Stolker.La malformazione cistica adenomatoide, di tipo III sec. Stolker si può presentare come una massa solida, ipodensa alla TC.Essa inoltre ha sede frequentemente paramediastinica. PS. il Bari malissimo in campionato: stiamo retrocedendo in serie C ! Ho recuperato “qualche punto” per la salvezza? Ma quei tubicini rx-opachi a cosa corrispondono?

      • Jose Caceres says:

        I don’t know what the tubicini represents. It may be lepidic growth of the carcinoma; but I cannot be sure.