Dr. Pepe’s Diploma Casebook: Case 57 – SOLVED!


Dear Friends,

This week we are presenting radiography of a 64-year-old man with dyspea. Examin the images below, leave your thoughts and diagnosis in the comments section, and come back on Friday for the answer.


1. Mediastinal mass
2. Pulmonary nodule
3. Aortic aneurysm
4. None of the above



Click here for the answer

Be Sociable, Share!

    27 Responses to : Dr. Pepe’s Diploma Casebook: Case 57 – SOLVED!

    1. sameh khodair says:

      I see a superior mediastinal opacity that fad out into the neck and attenuates the tracheal air column…retrosternal goiter. Also a well defined pulmonary nodule is seen in the right lower lobe so metastatic thyroid mass is considered

    2. Dragana says:

      None of the above
      Right hemitorax-in mediobasal segment seen consolidation

    3. gus says:

      Rheumatoid factor (RF)is normal?

    4. Anna says:

      I can clearly determine round opacity in LLL, I can also speculate that there are round masses behind a trachea. So, enlarged lymph nodes in the mediastinum suspected and CT indicated.

    5. Dr. Pepe says:

      Where are the usual suspects? I miss you all

    6. genchi bari italia says:

      ….opacità omogenea dell’angolo cardio-frenico di dx, che “maschera”il margine cardiaco inferiore( segno della “silhoutte”) indicante una patologia del lobo medio, come si vede in LL….tale opacità è compatibile con atelettasia del lobo….una immagine nodulare si vede in LL a livello del bronco lobo medio…. modicamente sollevata la cupola diaframmatica omolaterale … come reperto collaterale gozzo “plongeant” in alto a dx….

    7. Laurens says:

      Is this patient under corticosteroid therapy?
      PTH levels are ok?

      • Dr. Pepe says:

        No corticosteroid therapy. PTH OK.
        Follow the KISS method. Answer is simple.

    8. gus says:

      We have a fat man with pericardial fat, with lower lung zone reticular pattern (fibrosis), pleural thickening on pulmonary base,and nodular opacities at the carinal level.
      Osteoporotic bones and ossification of the anterior longitudinal ligament.

      • Dr. Pepe says:

        What do you think of the nodular opacity in the lateral view and the bulge of the aortic contour in the PA?

    9. Laurens says:

      Possible aortic aneurysm of descending aorta.

    10. genchi bari italia says:

      …cisti broncogena….opacità rotodeggiante,a margini netti che impronta e disloca la trachea…. frapponendosi tra trachea ed arco aortico…. l’adiposità del soggetto e del seno mi hanno sviato la diagnosi…scusami….

    11. Laurens says:

      On profile view at the level of nodular opacity anterior vertebral osteophytes are prominent. Calcified anterior longitudinal ligament is displaced anteriorly. Osteophytes causing pseudolesion sign?

      • Dr. Pepe says:

        Good! Why it took you so long?

        • Laurens says:

          For the last 3 days radiology lectures all day, had to analyze case via mobile phone. 🙂 Next week I am back on my PC. 🙂

    12. Moustafa says:

      widening of the posterior mediastinal shadow at the PA view with prominent both hilar shadows, prevertebral opacity noticed on lateral view, concerning about neoplastic process in such age group for post contrast CT chest correlation

    13. Bibi says:

      anterior vertebral scalloping; prevertebral mass a middle/posterior mediastin; Aortic Aneurysm?

    14. BZ says:


    15. Akash says:

      Could this be ankylosing spondylitis ?