Dr. Pepe’s Diploma Casebook: Case 63 – SOLVED!


Dear Friends,

Today I am presenting the case of a 43-year-old man with lymphoma, admitted with fever and left pleural effusion. Radiographs were taken after pleural fluid drainage. Check the images below, leave me your diagnosis in the comments section and come back on Friday for the answer.

1. Pneumonia
2. LLL collapse
3. Pleural fluid
4. None of the above




Click here for the answer

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    14 Responses to : Dr. Pepe’s Diploma Casebook: Case 63 – SOLVED!

    1. Murzin says:

      Hi Dr. Pepe,

      On the lateral view image an atelectatic consolidation is visible with Damoiseau line suggesting LLL collapse with pleural fluid (small amount of flud is also visible in the right pleura)
      I think on the pa view I can see a slight miedastinal shift to the left.
      Of course drainage and central catheter are also visible.

      That’s my thought, we’ll see…

    2. Ana says:

      The opacity in the lower left pulmonary field seems to correspond indeed to a lung colaps (maybe not the entire LLL), and on the PA there is a poor visualisation of the L diaphragmatic silhouette. But looks more like atelectasis, not pneumonia (smaller volume of lung).
      No donut sign though, so not an effect from mediastinal lymph node enlargment.

      • Ana I says:

        I’d maybe take a look on echography if I were on shift in the ER (just to check if of liquin nature). 🙂

    3. dr.moustafa darwish says:


    4. gizem says:

      Collapse,i think

    5. gus says:

      i think is LLL collapse. we have lost of volume.
      > i like to now if is the first pleural fluid drainage
      > why the bullau is not posteriorly
      > if the patient had pneumothorax after thoracentesis

    6. pH says:

      Increased density of retrocardiac lung, contour of descending aorta not visible,
      Lateral view supporting these findings of LLL collapse.

    7. genchi bari italia says:

      iniziale atelettasia rotonda,da compressione ab-extrinseco del pregresso versamento pleurico.

    8. Bogdan says:

      inability to trace the normal left hemidiaphragm contour not only posteriorly and medialy due to LLL partial collapse but also in the anterior and lateral costodiaphragmatic recess
      patient rotated to the left, probably slight inferior mediastinal shift to the right
      intrathoracic bowel herniation?

      LLL collapse secondary to enterothorax, diaphragmatic herniation

    9. Dr. Pepe says:

      I believe all of you are very smart…

    10. bionda says:

      4. Non of the above.
      Left hemidiaphragm rupture.
      Dilated oesophagus filled with air.

    11. Sonja says:

      Bronchooesophageal fistula with air-filled esophagus, aspiration and atelectasis.

    12. Zeineb says:

      Lll collapsus