Dr. Pepe’s Diploma Casebook: Case 116 – SOLVED!

Dear Friends,

This will be the last Diploma Casebook case posted on the ESR Blog. Following the steps of Neymar, I have been offered a succulent contract by the European Board of Radiology and next year I will posting my cases on the EBR website, starting on Monday, January 15. I am excited about this new challenge and hope you will be too!

Radiographs of today’s case belong to a 76-year-old man with pain in the chest after a fall. 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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    Dec 2017
    DISCUSSION 9 Comments

    9 Responses to : Dr. Pepe’s Diploma Casebook: Case 116 – SOLVED!

    1. Beata says:

      Broken ribs on the right side.

    2. MK says:

      Good morning! Fracture of the 5 right costal arc, signs of médium sternotomy.
      There is an elongated aorta. Gynecomastia.
      There are some nodular opacities proyected over both inferior hemithorax perhaps because of skin lesions (in the lateral view there is a round cutaneal image next to the sternotomy) or pleural calcifications.

      There is an aereal image in anterior mediastinum…

    3. Mauro says:

      Hello. There is a fracture of the rt 6th rib laterally. I see prominence of the aortic arch and left pulmonary artery, and a small nodular opacity immediately above the left hilum. I also think that two inferior fragments of the sternal suture are located too deep.

      • Jose Caceres says:

        What do you think about the nodular opacity?

        • Mauro says:

          The contours are too rounded to be a vessel. I believe it could be a nodule in the aortopulmonary window, and I think it is visible on the profile image overlying the trachea. I would investigate further with CT. After a second look, I would also say that there is thickening of the rt paratracheal line.

    4. MaríaPA says:

      Multiple right rib fractures
      Ectopic gas, in subxyphoid position
      I’d like to compare w/ previum films, to check the sternotomy “wires”, because they’re broken
      I’m answering at a phone, cannot define better if there is or isn’t any pneumothorax.

    5. genchi bari italia says:

      …fratture costali a dx….rottura dei fili della sternotomia mediana, inferiormente e pneumomediastino….sospetto di doppio contorno dell’arco aortico , come da dissezione……Auguroni PROF. per le festività , per il prestigioso incarico e per il tuo Barca….per me continua la sofferenza per il mio Bari…..ti prego consultare il sito di pediatric radiology VCU e vedere i vincitori per il 2017….

    6. Ukaonu Chigozie Blessed says:

      A fracture is seen involving the angle of the 6th right rib,sternotomy wire, Prominence of both breast nipple at the 5th anterior ribs, somewhat patchy opacity at the right lower lung zone, and some calcification on the wall of the descending aorta.

    7. Jose Caceres says:

      The answer is: aneurysm of aortic arch. Congratulations to Mauro, who discovered the abnormality and placed it in the lateral view.