Dr. Pepe’s Diploma Casebook: Case 111 – The Wisdom of Dr. Pepe (Chapter 4) – SOLVED!

Dear Friends,

To continue with the fourth chapter of The Wisdom of Dr. Pepe, I am​ showing PA radiograph of a 57-year-old woman with asthenia.
What do you see?

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

Click here for the answer

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    14 Responses to : Dr. Pepe’s Diploma Casebook: Case 111 – The Wisdom of Dr. Pepe (Chapter 4) – SOLVED!

    1. Mk says:

      Good morning!!

      Ufff, I think the right paraspinal interface is displaced, perhaps because of osteophytes or neurogenic/spinal disease.

    2. Mk says:

      I need the lateral view!!!!

    3. Stevan Vasiljević says:

      Left paraspinal shadow approximately at the level of aortic knob, giving double contour. Presence of hilum overlay sign indicates lesion on the anterior or posterior mediastinum. Next step – lateral view.

    4. amir says:

      I think there is bilatral paraspinal shadaow in superior mediastiunm with smal Rt displacement of trachea … latral C x ray and CT Scane help. Mybe thymoma

    5. genchi bari italia says:

      …Prof. io guarderei meglio anche l’ilo di sx….

    6. Baruch Videan says:

      There is widening of the left paratrachial stripe (exacerbated by rotation) but still there. Slight prominence of the left hilum.
      There is also an ill defined opacity overlaying the 9th right posterior rib which does not have the usual apearance of a nipple shadow possible nodule.
      I would recommend CT next

    7. Jolanta says:

      double aortic arch shadow ?

    8. sht says:

      Undulating border aortic arch. ?diverticulum

    9. Doe says:

      Left hilum enlargement

    10. Jolanta says:

      bulge of the right paraspinal line ?

    11. Dr Pepe says:

      There is an obvious double contour of the aortic knob. The answer needs a lateral view and,eventually, a CT, which will be shown tomorrow.
      Congratulations to Stevan Vasiljevic who was the first to detect the abnormality

    12. ZHW says:

      Thank you for that excellent presentation. I am not a junior radiologist and have an interest in chest and always learn something.

    13. sabry says:

      lateral view needed .