Dr. Pepe’s Diploma Casebook: Case 66 – SOLVED!


Dear Friends,

Today I am feeling magnanimous, because vacation is approaching. I have prepared an easy case of a 75-year-old man with cough and moderate fever. What would you diagnose?

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



Click here for the answer

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    Dec 2014
    DISCUSSION 17 Comments

    17 Responses to : Dr. Pepe’s Diploma Casebook: Case 66 – SOLVED!

    1. Fares says:

      Hypovenstilated right upper lobe + elevation of the horizontal fissure caused by RUL atelectasis+ may be there is an assiciated pneumonia.
      Right pleural effusion on the lateral view.

    2. gus says:

      Golden S sign + donuts sign …suspicious for a bronchogenic carcinoma.

    3. saad says:

      atelectasia + derrame = carcinoma.

    4. Germaine says:


    5. Amàlia GL says:

      There is a triangular right apical opacity on the frontal view, with elevation of the minor fissure displaying a convex contour cranially, tracheal deviation to the right and elevation of the right hemidiaphargm. These signs suggest upper right lobe collapse. The minor fissuere looks like the S-sign of Golden and is suggestive of a neoplastic etiology causing atelectasis of the right upper lobe.

    6. Pio says:

      Cicatrical RUL atelectasis. It could be tuberculosis, maybe with activation (right pleural effusion).

    7. amgad says:

      heterogeneous opacity of the right upper lung lobe partially solid and partially showed air bronchogram, with mass effect in the form of shifting of the trachea to the right side and transverse fissure upwards, most likely of carcinoma, yet TB could not be totally excluded.

    8. genchi bari italia says:

      …male il Bari in” campionato”…..male ANCHE nella classifica del mitico Professore…..proviamo a fare risultato almeno qui…..è una lesione con “riduzione di volume” , come si può osservare, dalla risalita della piccola scissura, del diaframma e “shift” della colonna d’aria tracheale….la “chiave” di lettura è nei broncogrammi aerei , che nel caso di una atelettasia sono ristretti, mentre in una “carnificaqzione TB con allargati: in questo caso l’opacità “retrattile” ha bronchi ampi….pertanto la diagnosi è il numero 3:TBC….con la stima di sempre da Bari!!!!

    9. George says:

      bronchiectasis partial atelectasis consolidation RUP lobe
      pneumonia TB

    10. Eola says:

      how about endogenous foreign body in pneumonia?

    11. murzin says:

      Would coexistence od TB and cancer be possible? Just a thought… Something is not right with that atelectasis- I think ropy and nodular densities are visible…

    12. Hugo Correia says:

      Well, i think mostly of options 1) and 3).
      Definitely the loss of lung volume at the RUL should raise the possibility of carcinoma. However I don´t figure an exact S at the horizontal fissure, neither an hilar mass.
      By other hand the clinical scenario given is compatible with tuberculosis, and so is the image, so I would go for option 3)

      Abraço Hugo

    13. Dr.Pepe says:

      At this time of the week, I can say that all of you are correct. Carcinoma, lobar pneumonia and TB (in order of frequency) can all give this appearance. So, you all can get credit.
      This case is shown to present uncommon apperances of pneumonia (lobar pneumonia does not happen as often as the textbooks say).
      Than you for participating!