Dr. Pepe’s Diploma Casebook: Case 65 – SOLVED!


Dear Friends,

Radiographs of this week’s case belong to a 55-year-old woman, referred to our hospital for percutaneous biopsy of a lung lesion. Leave your thoughts and diagnosis in the comments section below and come back for the answer on Friday.

1. Carcinoma
2. Tuberculosis
3. Congenital lesion
4. Any of the above



Click here for the answer

Be Sociable, Share!
    Nov 2014
    DISCUSSION 29 Comments

    29 Responses to : Dr. Pepe’s Diploma Casebook: Case 65 – SOLVED!

    1. Ele says:

      Congenital lesion, but CT I would do mainly for excluding carcinoma. No percutaneous biopsy for now as the lesion may be vascular.

    2. ct says:

      congenital lesion

    3. Sameh Khodair says:

      I think that two important DD are ; AVM or Bronchocele

    4. Fares says:

      Well defined, uniform density, branching, and most probably vascular mass, located anterolateral from the right hilum in female aged between 55-60 years old. It seems that she has no symptoms.
      The first diagnosis is Pulmonary Arteriovenous Malformations.

    5. DR / ELSAYED KOTB says:


    6. Iman says:

      Lobulated opacity at the right middle lung zone, on lateral view seen superimposed on the hilum, oblong in shape,no air bronchogram ,no calcium could be suggestive of arteriovenous malformation for CT evaluation.

    7. Cocotet says:

      Arteriovenous malformation?

    8. Giovanni Battaglia says:


    9. Nikhil says:

      Right mid zone tubular branching opacity On frontal radiograph
      Retro sternal space shows overlying Tortuous vessel ending on to opacity
      Suggest Pulmonary AVM.

    10. genchi bari italia says:

      .. fare una biopsia polmonare senza fare “prima” una TC? La tc servirà sopratutto a stabilire la natura liquida e-o solida della formazione ed a fare una ricostruzione coronale della lesione…è se fosse una MAV come sostenuto da alcuni, cosa succederebbe ? Penso comunque che la formazione possa essere anche una Bronchiectasia ” a dito di guanto rovesciato”, per intasamento mucoide….resta valida l’ipotesi di un broncocele, ma “isolato” nel parenchima?Saluti da BARI…..

    11. Maher Sayadi says:

      Congenital lesion, most propably AV malformation.

    12. Mohammed Atea Ahmed says:


    13. AHMED GALAL says:


    14. balachandran says:

      congenital -is the answer

    15. Rania sobhy says:


    16. Rx.IC says:

      Congenital lesion. Bronchial atresia.

    17. ulrika says:

      Bronchial atresia

    18. gus says:

      Pulmonary arteriovenous malformation but first a CT is necessary.

    19. Dr. Pepe says:

      If it is an AV malformation, where are the afferent and efferent vessels?

    20. gaborini says:

      mucoid impaction

    21. cuenca says:

      Anomwlia congenita: Atresia bronquial y broncocele

    22. DR / ELSAYED KOTB says:


    23. Sabra says:

      Finger in glove sign? ABPA

    24. Dr. Pepe says:

      As always, a correct interpretation is the clue to a correct diagnosis. The “V” shape pointing towards the hilum is indicative of mucous impaction. This appearance may occur in the three proposed options. Therefore, the correct diagnosis is 4. All of the above.
      To diagnose a congenital lesion, a zone of surrounding hyperlucency is needed (see CT in the answer)
      Congratulations to Drs. Ele and CT

    25. Sameh Khodair says:

      and me also 🙂 ….I meant by bronchocele is a mucoid impaction in a broncheole

    26. nasreen says:

      any of the above.Brochocele, mucus impaction