Dr. Pepe’s Diploma Casebook: Case 11 – SOLVED!

Dear Friends,

Since some of you misdiagnosed the right aortic arch in case 9, I will give you another chance with another mediastinal case in a 45-year-old man, who is asymptomatic.

Fig. 1


1. Pericardial cyst
2. Pericardial fat pad
3. Thymic tumour
4. All of the above

Click here for the answer

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    27 Responses to : Dr. Pepe’s Diploma Casebook: Case 11 – SOLVED!

    1. Burak says:

      Thanks for the great case.I hope that this cases Will survive till ECR.
      There is a round nodular, central radiolucency and rim capsular like lesion at the apex öd the heArt. This lesion is over the diapragm and inlerior the manibrium.. This can be a pericardial cyst.

    2. Dr J says:

      Pericardial Cyst.

    3. Mihai Comsa says:

      1. Pericardial cyst

    4. Artur says:

      Pericardial Cyst

    5. Dr Hesham says:

      pericardial cyst

    6. The answer correct Is number 4

    7. Kelvin says:

      Pericardial cyst…typical location (right cardio-phrenic angle), not of fat density (ie does not look like a pericardial fat pad).

      • Dr. Pepe says:

        What does pericardial fat pad look like?

        • Kelvin says:

          Hmmm…I am changing position here. Pericardial cysts are more homogenous and more discrete…and most of all more cyst like (round/oval).

          On second thoughts, this looks more like a pericardial fat pad…triangular, does not produce a silhouette with the heart.

    8. Dr OMS says:

      Pericardial cyst??

    9. George says:

      1)Pericardial cyst.
      2)Pericardial fat pad high density

    10. Genchi Bari Italia says:

      Premesso che non si può differenziare sulle radiografie standard una cisti pericardica da un cuscinetto adiposo dell’angolo cardio-frenico, in quanto entrambe rx-opache, a me sembra invece che si tratti di una ernia di Morgagni a contenuto adiposo peritoneale: il profilo diaframmatico dx , anteriormente non è bel visibile ed invece si intuisce una opacità che sale dalla cavità addominale (vedi radiogramma LL).

    11. maria says:

      pericardial fat pad

    12. Albert says:

      Classic differential of cardiophrenic angle opacity includes pericardial cyst, pericardial fat pad and Morgagni hernia.
      It’s round shape and homogeneity (vs Morgagni) as well as the assimetry in the contralateral side (vs fat pad) makes me choose pericardial cyst as my first option.

    13. Clau says:

      Pericardial cyst

    14. Rahul says:

      There is a rounded lesion which obscures the right heart border indicating that this is located in or is in contact with the middle mediastinum. The well defined lateral margin indicates contact with adjacent middle lobe lung parenchyma. The high density of the lesion and rounded shape does not fit with an epicardial fat pad. The low location of the mass and the normal retrosternal clear space goes against a thymic tumour. A pericardial cyst is therefore the most likely diagnosis.

    15. Irene says:

      Thymic tumor due to its location in the anterior mediastinum

    16. yasir says:

      I must offer my gratitude and a lots of thanks for uploading such awesome educational material for us residents. Thanks a lot Dr Caceres. I hope you continue this process. You are a source of inspitaion for us.