Dr. Pepe’s Diploma Casebook: Case 113 – SOLVED!

Dear Friends,

Glad to be back. I have missed my fans! Planning big surprises for next year. In the meantime, have a look at this preoperative chest radiograph for goiter in a 47-year-old woman. What do you see?

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

Click here for the answer

Be Sociable, Share!
    Oct 2017
    DISCUSSION 23 Comments

    23 Responses to : Dr. Pepe’s Diploma Casebook: Case 113 – SOLVED!

    1. bujar says:

      HELLO !
      Is a gastric patient ?

    2. bujar says:

      Is a gastric pacient ?

    3. DrPedro says:


      thickening/mass of the right apical pleura.
      the patient is rotated.

    4. Borsuk says:

      I think that left hilum is enlarged with polycystic shape – lymphadenopathy?

      • Dr Pepe says:

        Remember that hilar pathology increases the density of the hilum, which does not happen in this case.

    5. tr says:

      the rotated patient position degrades the evaluation, especially for the hila and mediastinum.
      The cxr is unremarkable.

      • Dr Pepe says:

        There is mild rotation, but it does not impede seeing the abnormality.
        I never present normal studies. It is demeaning for all of us.

        • TR says:

          agree with MP that there is a hyperlucent lesion over the right cardiophrenic angle, ddx: bowel containing morgagni hernia, lung bulla/bleb,.

    6. sabry says:

      upper mediastinal paratracheal mass

      • Dr Pepe says:

        I think what you call a mass is the sternal manubrium, visible because of the slight rotation of the patient

    7. MP says:

      there seems to be a rounded lucency in the right cardiophrenic angle. I would think pericardial cyst vs Morgagni hernia.

    8. Daniel Furlanetto says:

      I agree with MP, lucency in right cardiophrenic angle… but would think of an esophageal diverticulum. Upper GI tract fluoroscopy would be nice both to confirm it and better delineate gastroesophageal junction.

    9. R v says:

      Air fluid level in right cardio phrenic angle and also on left paracardiac region inferiorly- achalasia /Morgagni hernia

    10. Priya says:

      Rotated film
      Widening of the right paratracheal stripe
      Dense line along the mediastinal pleura
      Ddx: pleural mass, superior mediastinal mass

    11. Maksim says:

      Loop-like density in the right lower lobe. I think it may be cavitary lesion

    12. bujar says:

      Displacement of the Azygooesophageal line, obscuring the right hilum. Susp.oesophageal disease.

    13. Genchi bari italia says:

      ….carissimo prof…..la paziente ha subito un intervento chirurgico al seno dx…..quella immagine rotondeggiante, rx- trasparente, può” rappresentare un segno delle tante tecniche di mastoplastica ricostruttiva….vicino alla Catalogna….

    14. Dr Pepe says:

      By this time of the week I imagine all of you know the answer: a fluid-filled cyst in the right cardiophrenic angle. Get more information tomorrow.
      Congratulations to MP, who was the first to see the abnormality.

    15. genchi bari italia says:

      …grazie per la lezione PROFESSORE !

    16. Manoj P Jose says:


      Excellent discussion

      I would like to point out that the subtitle given for figure 9 is a repetition of subtitle of figure 8

      Thank you