Dr. Pepe’s Diploma Casebook: Case 18 – SOLVED!


Dear Friends,

My second case of 2013 relates to a 49-year-old man with shortness of breath. PA and lateral radiographs are shown.



1. McLeod syndrome
2. Pulmonary embolism
3. Pneumothorax
4. None of the above

Click here for the answer

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    12 Responses to : Dr. Pepe’s Diploma Casebook: Case 18 – SOLVED!

    1. Evan says:

      PE with Westermark sign?

    2. Peter says:

      Oligemia of left lung – Westermark’s sign due to pulmonary embolism

    3. Alice says:

      Diminished vascularity on the left, the left hilum is lower than usual.
      No Westermark sign or hamptons hump visible.
      No Pneumothorax either (although there are surgical Clips on the right likely in the thoracic wall- Cause?)

      I choose no. 1 swyer-james-mcleod

    4. Maria says:

      McLeod syndrome

    5. Jorge says:

      Swyer James – McLeod

    6. shahid goni says:


    7. genchi bari italia says:

      Non c’è nè il segno di Westembark, completo, nè il segno di Hampton hump-sign: escludo la Embolia polmonare. Non si vede aria libera in torace. Vi è oligoemia, con iperventilazione , apparente del polmone sx che ha un”volume” inferiore al controlaterale, pur essendo “apparentemente”, iperespanso: quindi sono per la S. di Swyer James -McLeod.

    8. Bruno says:

      In Westermark sign the oligoemia is more evident. I agree with Mcleod Syndrome.

    9. Dr. Pepe says:

      A word of caution to all of you who answered McLeod: diagnosis cannot be made unless you have an expiratory film that demonstrates air-trapping

    10. genchi says:

      In effetti quello che non si spiega è “l’apparente iperventilazione” del polmone sx , con “perdita” di volume dell’emitorace corrispondente e lieve attrazione omolaterale dell’ombra cardio-mediastinica; inoltre in LL si osserva una banda di opacità contro l’immagine cardiaca, nonchè una opacità triangoliforme contro l’ombra cardiaca , alla base polmonare in AP.Pertanto raccogliendo, per buoni , questi altri segni si potrebbe anche supporre una atelettasia del lobo polmonare inferiore sx, ed iperventilazione, per compenso, del lobo superiore.

    11. Dr. Pepe says:

      Since no more answers are forthcoming, I believe final diagnosis can be disclosed. As Genchi Bari said, we are looking at compensatory LUL emphysema, secondary to LLL collapse. It is important to get the findings right to avoid diagnostic mistakes. Detailed answer will be posted shortly.
      Congratulations to Dr. Genchi Bari!

    12. genchi bari italia says:

      Grazie collega dr Pepe ,Il “galactico” sarà contento …..di questo piccolo Bari!