Caceres’s Corner Case 63 (Update: Solution)


Dear Friends,

My former disciple Jordi Andreu has contributed this week’s case. Below is a pre-operative PA chest radiograph of a 27-year-old male with a growing perineal mass.


1. SVC obstruction
2. Coarctation of aorta
3. Lymphoma
4. None of the above

PA chest

Click here for the answer to case #63

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    Apr 2013
    DISCUSSION 18 Comments

    18 Responses to : Caceres’s Corner Case 63 (Update: Solution)

    1. muneesh sharma says:

      2. coarctation of aorta

    2. maria says:

      coarctation of aorta with inferior rib notching and scoliosis

    3. genchi bari italia says:

      TOS( Thoracic Outlet Syndrome ) da costa cervicale accessoria, bilateralmente: Fascio vascolare del Collo ( ECD dei tronchi sovra-aortico, con prove dinamiche degli arti superiori per rilevamento polso radiale).

    4. gus says:

      there is notching of the ribs under 3 rib bilateral und scoliosis.we dont see the aortic comb.
      dilatation of pulmonary hilum but not in periphery.
      we see both nipples und dilatation of superior mediastinum.
      i thing coarctation of aorta

    5. Alice says:

      There is widening of the upper mediastinum bilaterally and increased density, probably due to vascular structures (lymphadenopathy is not that symmetrical).
      Also there are dense structures projecting on the apices, of soft tissue density – therefore i am not convinced of accessory ribs… Also vessels? Enlarged collaterals?
      In addition the rib notching… I choose coarctation.

    6. Katerina says:

      Tricky case with only AP view ….
      at first glance it seems like coarctation of the aorta
      but …
      – bilateral widening of the superior mediastinum continues above the level of the clavicles to join with
      – symmetrical dense extrapulmonary lesions which project at the apices (not accessory ribs)
      – widening of the left paraspinal line
      – no tracheal deviation
      so …
      these findings can not be situated in the anterior or middle mediastinum.
      They must be situated in the posterior mediastinum (neurogenic tumors? extramedullary haemopoiesis?)
      so …
      I choose 4.none of the above

    7. Xose says:

      Like Katerina, I think there is widening of superior mediastinum extending to both apices.
      I also choose 4. The presence of another mass at the perineum suggest a diffuse disease like neurofibromatosis, plexiform neurofibromas?

    8. Majed Aldhubayb says:

      Coarctation of aorta with figure of 3 sign and inferior rib notching

    9. Genchi bari italia says:

      Perchè non è stata mostrata la LL? Il “trucco” è tutto li’? Una immagine di sovrapposizione di qualcosa che è appesa al collo ?Una ” trappola” del professore?

      • Jose Caceres says:

        It is not a “trappola”. Since it was a pre-operative study, only a PA was taken. In my opinion, PA and lateral should be obtained always; but not everybody agree.

    10. Ricardo Macareno says:


    11. Jose Caceres says:

      So far, nobody has asked if the patien has hypertension!

    12. genchi italia bari says:

      L’origine della ipertensione: nefro-vascolare?

    13. Lola la Piconera says:

      4. none of the above
      Scoliosis, ribs notching, bilateral apical extrapulmonary lesions, and mediastinal widening can be seen all together in a patient with neurofibromatosis (NF) like this one.
      I wouldn´t say this patient have pulmonary hipertension (PH).
      Are there any association between NF and PF?
      Nipples are a bit assymetric. May be one of the “nipples” is a cutaneous neurofibroma.

    14. Katerina says:

      I think that the patient has no arterial hypertension, and no difference in arterial pressure between upper and lower extremities. Do you agree, Mr Muppet?