Dr. Pepe’s Diploma Casebook: Case 107 – To err is human: how to avoid slipping up (Chapter 6) – SOLVED!

Dear Friends,

To conclude the section “To err is human” I am presenting PA radiographs of a 57-year-old hairdresser with interstitial lung disease, who is on the waiting list for lung transplant. What do you see?

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

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    8 Responses to : Dr. Pepe’s Diploma Casebook: Case 107 – To err is human: how to avoid slipping up (Chapter 6) – SOLVED!

    1. ren says:

      hello professor.
      In this xray there are reticular opacities in bilateral lungs right > left likely fibrotic changes.additionally, cystic and tubular lucencies in the right lung predominantly in parahilar region representing bronchiectatic changes. Lower zones are relatively spared. Follow up xray after an year shows reduction in the opaciites – ? post steroid. however, there is increased/ persistent irregular opacity in the right middle zone along with the pleural thickening along the right lateral thoracic wall In a patient of ild ,I would be concerned to rule out a malignancy. hence would advise a ct scan. Of incidental note is the azygous fissure.

    2. MK says:

      Good morning,

      Peribroncovascular thickening, more visible at paracardiac margins because of intersticial pathology.

      Acigos fisure is present.

      Hypertrophic of the first rib articulation.

    3. Dear Dr. Pepe

      Additionaly to all the fibrotic changes I think there’s a mass in the right middle pole that grew twice over the year.


    4. 19Medicus83 says:

      Dear Professor,
      Maybe posttherapeutic reduction in reticular opacities in both lungs.
      I´m also concerned of a subtle hazy density in the right lateral lung field corresponding to a pleural mass, DD: coarse lung malignant lesion. Underlying ribs seem to be intact.

    5. genchi bari italia says:

      ….Stimatissimo Prof. …la patologia è a carico del lobo accessorio v: azygos…..la scissura era ben visibile nella radiografia 2014….non più visibile nel 2015, per probabile retrazione atelettasica del lobo, da processo produttivo…..simpaticissimo prof. ti avevo avvertito che Dybala sarebbe stato il vostro incubo….per il mio Bari, sempre più figure inguardabili….

    6. Jose Caceres says:

      Thanks to all five brave people that participated. Kudos to Ren, who was the first to do the right diagnosis.
      More information tomorrow