Dr. Pepe’s Diploma Casebook: Case 64 – SOLVED!


Dear Friends,

Showing today pre-op radiographs for knee surgery of a 17-year-old girl. Check the images below, leave your diagnosis in the comments section and come back on Friday for answer.


1. Branchial cyst
2. Neurogenic tumour
3. Lymphocele
4. None of the above



Click here for the answer

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    Nov 2014
    DISCUSSION 13 Comments

    13 Responses to : Dr. Pepe’s Diploma Casebook: Case 64 – SOLVED!

    1. Cocotet says:

      The iris heterochromia suggests me neurofibromatosis therefore it may be neurogenic tumour?
      Moreover it is not water density in CT so i discard the other two options.

    2. gus says:

      Lisch nodules NF1

      • Jose Caceres says:

        Quote from the NEJM: “Lisch nodules are melanocytic hamartomas that appear as well-defined, dome-shaped elevations projecting from the surface of the iris and are clear to yellow or brown”. Does this patient have Lisch nodules?

    3. dr_Dimitrova says:

      Branchial cyst

    4. gus says:

      She didn’t come for her eyes that means is something not acquired recently.
      the mass extends above the superior clavicle on the face view so it is located either in the neck or in the posterior mediastinum.
      on CT the mass it looks like solid from the neck to the mediastinum
      Lisch nodules NO
      Waardenburg syndrome NO
      Congenital Horner’s syndrome ? but we don’t have all the symptoms of Horner’s syndrome

      • Jose Caceres says:

        This case was diagnosed by the resident searching the web. Of course, you have to look for the right information. This is why it is important to make a correct interpretation of the findings.

    5. burak says:

      paraganglioma ?
      schwannoma ?

    6. Konstantinos Drevelegas says:

      It is probably a lesion of the posterior mediastinum. I go for lymphocele.

    7. genchi bari italia says:

      ..eterocromia, ma anche mosaicismo somatico occhio dx, da S,di Claude-B-Horner, per neuroblastoma toracico.

    8. Mirzada Irshad says:

      Cervicotoracic sign. Means most probably the mass is in posterior medistnium. Most peobably neurogenic tumor. Schwanoma with iris color change … Will go for NF 1.

    9. Dr. Pepe says:

      It’s Thursday evening and time for recognition. Congratulations to Cocotet, who was the very first to suugest the diagnosis and to Genchi Bari, who made the exact diagnosis.
      Full information tomorrow.
      Have a nice weekend.

    10. genchi bari italia says:

      ….grazie PROFESSORE…..NB.il Bari ANCHE in serie B va male…Anche per il BARCA i tempi bui passeranno !!!!!