Dr. Pepe’s Diploma Casebook: Case 43 – SOLVED!


Dear Friends,

Today I’m presenting radiographs of a 54-year-old male with chest pain (below).

Would you call these radiographs normal?
If not, where is the abnormality?

Leave me your answers in the comments section and look out for the answer on Friday.



Click here for the answer

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    14 Responses to : Dr. Pepe’s Diploma Casebook: Case 43 – SOLVED!

    1. Panagiotis Maidas says:

      Donught sign

    2. Katerina says:

      Tricky case Dr Pepe !!! The resolution of the Xrays doesn’t help much.
      Nevertheless, I think that in the AP view there is an opacity projecting in the apex of the left lung and also destruction and sclerosis of the posterior end of the 3rd left rib.
      No abnormalities in the profil view.
      Pancoast tumor? Posterior thoracic wall tumor?

      • Dr. Pepe says:

        I am tricky, but just! I agree with your comment about the resolution. Will send you the original images.
        There is no destruction or sclerosis of the third rib.

    3. Bahnassy says:

      In PA view :There is an opacity at the right side of the carina I the lateral view :it is projecting anterior to the air filled airway ,and showing thick walled cavity that was not apparent in PA view .(DD:bronchogenic cyst_)

    4. Yp says:


    5. András says:

      I also think that there is a small lesion in the apex of the left lung, though I do not think that it is the cause of pain. As always, cant wait till Friday 🙂

    6. gus says:

      i think professor gives as the answer.
      is a phantom tumor.

    7. Vilma says:

      I agree with Katerina, i think that there is a lesion in the apex of the left lung. Neurinoma? Pancoast tumor?

    8. genchi bari italia says:

      molto tenue opacità rotodeggiante a limiti netti all’apice del polmone sx, che in LL non si riesce bene a definire.

    9. Marcy says:

      Left upper nodular mass, lateral ,medial and inferior borders can be defined, it seens they are kindy irregular, but superior marging are barely visible. Could correspond with san intrapulmonary nodule.

    10. Dr. Pepe says:

      Since tomorrow you will know the answer, I can advance that the patient has a 3 cm rounded mass in the left apex. This case is shown to emphasize the importance of looking at the apices. More to come!

    11. Edilberto B. Dominguez says:

      hazy densities noted in the apical portion of the left lung which could be fatty tissues. Can we call this as apical cap sign?