Caceres’s Corner Case 57 (Update: Solution)

ESR_2012_Blog-CaceresCorner-590-CASE572

Dear Friends,

Dr. Manel Martínez, a long-time friend of the Muppet, has provided the following case: an asymptomatic 67-year-old man in whom a mass was discovered in the chest radiographs.

Diagnosis:

1. Aortic aneurysm
2. Hydatic cyst of lung
3. Left pulmonary artery aneurysm
4. None of the above


PA chest, asymptomatic 67-year-old man

PA chest, asymptomatic 67-year-old man

lateral chest, asymptomatic 67-year-old man

lateral chest, asymptomatic 67-year-old man

Click here for the answer to case #56

Final diagnosis: saccular aneurysm of descending aorta.

Teaching point: when seeing lineal peripheral calcification, think of cyst vs. vascular (Dr. Pepe dixit).

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    Mar 2013
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    DISCUSSION 18 Comments

    18 Responses to : Caceres’s Corner Case 57 (Update: Solution)

    1. muneesh sharma says:

      thoracic descending aortic saccular aneurysm

    2. Ricardo Macareno says:

      Saccular image that identifies edge mediastinal deforms under the second left aortic arch. Finding suggestive of left pulmonary artery aneurysm

    3. Ricardo Macareno says:

      It is an aspect vascular mediastinal mass that appears to originate in the left pulmonary artery.
      True, it is very rare but I consider it an aneurysm of the left pulmonary artery.

      Sorry for my bad English.

    4. Ricardo Macareno says:

      Rectified, thanks for your comment. It certainly seems to have no hilar origin. Anyway I have my doubts that originates in the aorta.
      Still think …………………….

    5. ashraf aohadeed says:

      CXR , frontal and lateral views : a large well defined mass is seen projected overlying left hilum , left pulmonary artery is seen clearly , so this mass is either anterior or posterior to the left hilum , lateral view revealed posterior location to the hilum .
      aortic contour is intact , not dilated in 67 years old male but localized saccular aneurysm is a possibility .
      another possibility to be hydatid cyst especially , presence of thin calcific rim along left lateral border , another possibility in asymptomatic case is bronchogenic cyst . another possibility is posterior mediastinal mass as neurogenic tumor .
      so CT scan is advised .

    6. Choupinette says:

      Hello,
      If we apply” hilar convergence sign”, we are not supposed to see left pulmonary artery behind the mass if the mass has a vascular origin, isn’t it?
      in this case, we can clearly see LPA and its branches behind the mediastinal opacity ; besides the thin calcified rim can be highly suggestive of mediastinal hydatic cyst , that can take place in any mediastinal compartment .
      so it should be the most likely diagnosis according to me…

    7. gaborini says:

      Señor Pepe dijo hace unas semanas – “A very important finding is the discovery of peripheral linear calcification. This type of calcification points to two possibilities:
      a cystic lesion or a vascular structure.”

      Hence, I go with bronchogenic cyst, since aorta and left pulmonary artery are not obliterated, and hydatid cysts don’t tend to calcify when in the lung.

      • jose caceres says:

        Dr. Pepe thanks you for remembering his advice. Discovering he linear calcification gives you a 50/50 chance.
        Why do you say that the aorta is not obliterated? Do you see the line of the descending aorta?

    8. Jordi Broncano says:

      Saccular descending aortic aneurysm

    9. Ricardo Macareno says:

      broncogenic cyst

    10. genchi bari italia says:

      L’opacità è nel mediastino medio.Essa ha limiti netti, con sottile linea calcifica esterna e “spot” calcifici interni.L’aorta e l’arteria polomonare sx sono chiaramente visibili ed indenni; una cisti idatidea non ha una sede perilare e non contiene calcificazioni.L’ipotesi diagnosticaKISS è una cisti broncogena mediastinica, adesa al bronco principale.Il paziente è asintomatico.

      • Jose Caceres says:

        It could very well be a duplication cyst, but with the KISS hypothesis I would say an aortic aneurysm should be more common.

    11. genchi bari italia says:

      habemus “Messi””: complimenti per il caso e la “remuntada”!Ora vi “apetta” la Iuventus !

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