Dr. Pepe’s Diploma Casebook: Case 104 – To err is human: how to avoid slipping up (Chapter 3) – SOLVED!

Dear Friends,

Today I am presenting chest radiographs taken during a routine check-up of a 60-year-old woman. Radiographs were read as normal. What do you see?

Check the images below, leave your thoughts in the comments section, and come back on Friday for the answer.

Click here for the answer

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    18 Responses to : Dr. Pepe’s Diploma Casebook: Case 104 – To err is human: how to avoid slipping up (Chapter 3) – SOLVED!

    1. tr says:

      i can see bulging of the aorto-pulmonary stripe on the AP view with a small correspondent ovoid density on the lateral view.
      Impression: aorto-pulmonary window lesion.

    2. MK says:

      Good morning!

      There is an increased density in the apical portion of the left hemithorax compared to the right one.

      The hilum are prominent. Both have a well defined inferior margin, and in the lateral view I think there is a nodular lesion with center high density (calcium?), perhaps adenopathy?

    3. Fatemeh shaki katouli says:

      I see an ovoid hilar region in left hilum which shows a focus of calcification

    4. Olena says:

      Agreed with MK – I see the same changes, but calcium in “nodular lesion” suggesting calcified limph node after tuberculosis and the slightly increased density in left apex due to fibrous changes of the lung parenchyma after healed TB.
      Besides, there is pleural thickening on lateral view in the main fissure which slightly deformes the diaphragmal contour

      Changes after lymphatic nodules and lung tuberculosis

      • Olena says:

        The bulging on left mediastinal contour just below the arcus aortae suggesting – “conus pulmonalis” due to hypertension
        Cardiologist consultation needed

    5. Pepita says:

      Fat pad sign on profile pic.suggests small perikardial effusion

    6. Sofia Nikolakopoulou says:

      Anterior mediastinum mass.

      • Dr Pepe says:

        Older people tend to have an elongated ascending aorta, that impinges in the anterior clear space. No anterior mass was found at CT.

    7. tr says:

      i think it is hard to tell if the lesion is in the anterior or middle mediastinum because of the close relationship between the AP stripe and AP window. but I favored the AP window/middle mediastinal lesion because I imagined a small nodule there on the lateral view!.

    8. Borsuk says:

      There is prominent pulmonary artery with prominent vascular hilas probably with cut-off – I think about pulmonary hipertension.

    9. genchi bari italia says:

      …il Bari sta scivolando verso ….l’alto….ma quello che vedo è verso il ….basso…..ampliamento del forame di coniugazione intervertebrale tra D10 e D11…

    10. Y.E. says:


      Bilateral hilar nodal enlargement.
      Possible diagnosis: Sarcoidosis.

    11. Dr Pepe says:

      Back from ECR Congress. Congratulations to all of you who saw the bulge in the aorto-pulmonary window, with special mention to
      tr, who was the first