Dr. Pepe’s Diploma Casebook: Case 55 – SOLVED!


Dear friends,

Today I am presenting today chest radiographs of a 48-year-old man with previous resection of a carcinoid tumour of the ileum. Check the images below, leave your thoughts in the comments section and come back on Friday for the answer.


1. Granulomas
2. Amyloidosis
3. Calcified metastases
4. None of the above



Click here for the answer

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    23 Responses to : Dr. Pepe’s Diploma Casebook: Case 55 – SOLVED!

    1. Andrés Rojas says:

      Calcified chondrocostal cartilagues

    2. Luigi Cocco says:

      Calcificazione di alcune coste anteriori con iperostosi. Metastasi scheletriche?

    3. hoangduc says:

      I think is Calcified metastases

    4. gus says:

      costal cartilage calcifications ?

    5. Dr. Pepe says:

      At least one of them is offside the rib. This goes against your diagnosis

    6. gus says:

      there is correlation with carcinoid tumor?

      • Dr. Pepe says:

        If I say no, you would eliminate option #3. And if I say yes, you will choose it.
        My option: not saying a word.

    7. Maria says:

      What about chondroid tumors? (multiple enchondromas(maffucci)? chondroblastomas?) I believe there is matrix calcifications.

    8. Laurens says:

      Besides lesions mentioned before it seems to me there is widening of upper mediastinum seen on PA view (eg. above aortic arch in left paratracheal region convex contour).
      If metastases are excluded , could it be neurofibromatosis?

    9. gus says:

      Carcinoid skin metastasis ?

    10. genchi bari italia says:

      …in LL sembrano osservarsi delle alterazioni destruenti a carico dello sterno con reazione periostiosica….potrebbe essere un tumore dello sterno con metastasi pleuriche….

    11. genchi bari italia says:

      ….e noduli “silicotici” non poteva essere la risposta giusta?Solo l’anamnesi, in questo caso, poteva determinarne la esatta etiologia….

      • Dr. Pepe says:

        Sorry, my friend. Silicotic nodules are widespread, smaller and do not cling to the periphery. Do not feel bad. The problem cases are just an excuse to discuss (and, hopefully, teach an specific pattern).

    12. DON says:

      It is not at all neurofibromatosis it’s just a simple pleural calcification. easy dr.pepe send some tough diagnosis.

      • Dr. Pepe says:

        For tough ones you have to go Cacere’s corner. I haven’t seen you there.