Dr. Pepe’s Diploma Casebook: Case 102 – To err is human: how to avoid slipping up (Chapter 1) – SOLVED!

Dear Friends,

Today we’ll start the second part of The Beauty of Basic Knowledge series, titled ‘To err is human: how to avoid slipping up’. In the next six chapters I intend to analyse the most common causes of errors in chest imaging and how to avoid them. As Cicero said: All men can err, but only the ignorant persevere in the error.

This week I am presenting two cases. Case 1 shows the PA radiograph of a 57-year-old man with a cough. Would you say the chest is normal?
3.Need a lateral view
4.Need a CT

Case 2 presents PA and lateral radiographs of the yearly check-up of a 70-year-old man. CT done in another institution was reported as chronic post-TB changes. Do you agree?

Check the images below, leave your thoughts in the comments section and come back on Friday for the full solution!

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    17 Responses to : Dr. Pepe’s Diploma Casebook: Case 102 – To err is human: how to avoid slipping up (Chapter 1) – SOLVED!

    1. MK says:

      In case 1, there is a widening of the right superior paratracheal line. I would like to check the lateral view, but if only I can choose one complementary study I prefer a CT.

      In case 2 there is a loss of volume of the right hemithorax with a superior elevation of the hilum and hemidiaphragm. An atelectasia of the ULL? I can not say the cause of this with only a radiography.

    2. Sheriff says:

      Case 1: I see a pulmonar nodule at the right base. I would like a lateral view, too check if it’s or not a real nodule (nipples?).

      Case 2: I see a lost of volume of the right hemithorax and a pseudonodular image/enlargment of the superior margin of the right hilum, it could be post-tbc changes, but a CT image or previous studies would be great

    3. Mahmoud says:

      Both cases show reduced volume of right hemithirax, subtle mediastinal shift to right side, depressed right hilum, finding are suggestive of right lower lobe collapse in both cases.
      In case 2: there is triangularity opacity in lateral view in posteroinferior corner which represent the collapsed right lower lobe
      In case1: the lateral view is recommended next.

    4. Vivi says:

      In the first case I think there is a round opacity on the right lung (middle to lower portion of lung) and firstly I would like to see a lateral view to confirm the existence of the finding and furthermore to assure that it is an intraparenchymal lesion.
      In the second case I think there is volume loss of right lung, and hyperventiltion of the left lung. I can also see opacification of right apex, propably because of URL collapse (in my opinion also right hilum is a bit elevated).endobrochial mass cannot be excluded.

    5. Borsuk says:

      I fully agree with Mahmoud in case 1 – round opacity in the middle zone of right lung – need lateral for further investigation of location of the lesion.
      In case 2 I think there is lingula segment atelectasis with corresponding hiperinflation of left lung. Left hilar mass need to be excluded.

    6. Pepita says:

      Case 1- tracheal narrowing just above bifurcation, tm? vascular anomaly? lymphadenopaty?.
      Case 2- retrosternal opacification – segmental atelectasis of RUL?

    7. Diogo says:

      case 1: it seems there’s an opacity superimposed on the right hilum, specifically on the ascending branch of the right pulmonary artery. A lateral view could be useful.

      case 2: RUL volume loss. Comparison with previous films or CT to evaluate possible endobronchial lesion.

    8. Cmnz says:

      Case 1: RLL atelectasis. First check previous films. Need lateral view. If confirmed, chest CT to rule out/in obstructive atelectasis.
      Case 2: RUL anterior segmental atelectasis expanding at the hilum in the lateral view. First check previous films, I think it is alway wise to do that to support the reading, but very suspicious for right hilar mass + obstructive atelectasis.

    9. Fabian says:

      Muchas gracias Dr.

    10. donita says:

      priceless information Dr.