Dr. Pepe’s Diploma Casebook: Case 62 – SOLVED!


Dear Friends,

Today I am showing PA chest and sagittal CT of a 66-year-old woman with a persistent RLL infiltrate and negative bronchoscopy. Check the images below, leave me your thoughts in the comments section, and come back on Friday for the answer.

1. Tuberculosis
2. Chronic aspiration pneumonia
3. Carcinoma
4. None of the above



Click here for the answer

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    27 Responses to : Dr. Pepe’s Diploma Casebook: Case 62 – SOLVED!

    1. AMR SAADAWY says:

      Bronchoalveolar carcinoma = minimally invasive adenocarcinoma

    2. genchi bari italia says:

      ….regola KISS….non adenopatie….broncogrammi aerei….Cronica aspirazione polmonite….alla BAL , macrofagi !Scusa se continuo a rispondere in italiano, ma non so l’inglese e , per questo motivo, non prenderò mai il Diploma….!!!!Sempre comunque affezzionato fans…..

      • Jose Caceres says:

        Don’t worry. Italian is easy to understand. And we always have google translator!
        As far as I know, you can take the oral Diploma examination in your native language

    3. Eugenio says:

      Bad location for TB, no lymph node enlargement.
      Good location for aspirarion pneumonia, and I feel there is left side compromise on the Xray.
      With air broncogram, it could be adenocarcinoma or lymphoma, but in think this case is bilateral.

      I choose aspirarion.


    4. Amira says:

      Right lower posterior segment consolidation with air bronchogram,, suggestive of chronic aspiration pneumonia

    5. mahwash says:

      consolidation, D/D includes broncho alveolar carcinoma

    6. sumat sharma says:


    7. Bassem Hassan says:

      4. None of the above.
      it is a intralobar sequestration (ILS)

    8. gus says:

      She’s got fever?

    9. gus says:

      I think the infiltration is bilateral.
      Chronic aspiration pneumonia?

    10. Lola la Piconera says:

      Good case for this season. The threes are loosing their sheets and the gardeners are going to prune them. So this case should be an Adenocarcinoma.

    11. Lola la Piconera says:

      My housband is gardener

    12. DR / ELSAYED KOTB says:

      if you agree with me that good history take for this patient will be useful with us as aspiration pneumonia is in my mind as the first choice as we see there is segmental distrubution of the opacity and is noted in an expected area for the aspiration pneumonia ., however follow up of the size of this lesion should be done to exclude any neoplastic lesion.

      thank you

      • Jose Caceres says:

        I agree with you that the clinical history is crucial in many cases. However, in this particular patient the imaging signs were the ones which pointed to the right diagnosis.
        Thanks for participating.

    13. Jose Caceres says:

      At this time of the week I believe I can safely disclose the diagnosis: adenocarcinoma of lung, discovered because of the lefless tree sign. Full explanation tomorrow.
      Congratulations to Dr. AMR SAADAWY, who was the first to suggest the right diagnosis.

    14. genchi bari italia says:

      …..Stupenda lezione di semeiotica…..Grazie Galactico Professore !!!!!!

    15. gus says:

      great case professor!!! very useful course.

    16. abu aish says:

      Answer no. 2
      Chronic aspiration pneumonia

    17. drnguyenhuuquoc says:

      No 4.

    18. Rilinda Cela says:

      Chronic Aspiration pneumonia.My greetings from Albania.