Dr. Pepe’s Diploma Casebook: Case 68 – SOLVED!


Dear Friends,

This week I am presenting the radiographs of a 50-year-old man with chest pain. Check the images below, leave your thoughts and diagnosis in the comments, and come back on Friday for the answer.

1. Multiple myeloma
2. Tumor of sternum
3. Fibrous tumour of pleura
4. None of the above



Click here for the answer

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    25 Responses to : Dr. Pepe’s Diploma Casebook: Case 68 – SOLVED!

    1. Manish Khokhar says:

      Fibrous tumor of pleura

    2. Carmen says:

      tumor of sternum

    3. Draghy says:

      I go with answer no 3 fibrous tumour of pleura

    4. Nicky says:

      none of the above

    5. Sanjay Jain says:

      Multiple myeloma

    6. gaurav watane says:

      3. Fibrous tumour of pleura

    7. Adam says:

      4. None of the above.
      Dilated internal mammary artery – due to aortic stenosis?

    8. Maria Sidiropoulou says:

      Besides scoliosis of the thoracic spine and fibrotic findings of the RUL on the frontal view, I also see expansion of the sternal manubrium and an extrapulmonary lesion projecting behind the body of the sternum on the lateral view.
      Perhaps there is expansion of the anterior part of a rib on the lateral view also..Multiple myeloma cannot be easily exclued from the differential diagnosis. Increased density of TH7 is also noted.

      • Maria Sidiropoulou says:

        I would also like to add that the left pectoralis major is absent….Poland syndrome?

    9. gus says:

      I think is more than one lesions sub sternal,on posterior and lateral thoracic wall without bone involvement.
      i believe it’s pleural origin lesions(obtuse angle with the chest wall) but i am not sure if it is Fibrous tumour of pleura, (i know it’s solitary tumors).
      so a CT… is necesary 🙂

      • Jose Caceres says:

        You are contradicting yourself when you say that fibrous tumor is solitary and at the same time state that the lesions are multiple

        • gus says:

          i say there is multiple pleural origin tumors.that make’s unusual the presentation of a fibrous tumor.
          i vote CT 🙂 4

    10. giorgi says:

      only sqolioz…

    11. Diana Baptista says:

      Fibrous tumor Of the pleura.
      There is a mass behind the sternal body, which change its form in the lateral projection, and form open angles with the chest wall.

    12. genchi Bari Italia says:

      ….riduzione del DAP toracico, rispetto al DT toracico, con riduzione dello spazio r.c. Ed “apparente” cardiomegalia……si associa dismorfismo sternale, con lobulazioni (adipose?) retrosternali…..BACK STRIGHT S., con prolasso della mitrale che può’ spiegarmi dolori toracici….

    13. Predrag says:

      Costochondritis- Tietze syndrome

    14. Maher Sayadi says:

      Despit all the pleural soft tissue lesions and scoliosis but a Straight Dorsal Syndrom could be the cause of chest pain in this case.

    15. Maria Sidiropoulou says:

      I would also like to add that the left pectoralis major is absent….Poland syndrome?

    16. J.D. says:

      Chest radiograph of adult male. Multiple smooth thickening lesions along the pleural lining bilaterally, broad base towards the pleura giving undulating appearance. No calcifications within these lesion. No pleural effusion.
      Lungs and heart are otherwise normal. No loss of lung volume.
      Bones show diffuse osteopenic changes, but no focal lytic lesion or bone destruction.
      My answer is 4 – none of above. ?Pleural metastasis? Suggest CT Thorax and tentatively for pleural biopsy.

    17. Nikhil Mehta says:

      None of the above.
      It’s an extra pulmonary lesion, no underlying bone destruction.
      Opacity of lesion is less than soft tissue density, no calcification.

    18. Carlo says:

      Multiple pleural plaques. Asbestosis ?
      Mass: localized mesothelioma?
      What do you think?

      • Jose Caceres says:

        It is always a possibility, but fibrous mesothelioma is not related to asbestos. Asbestos-related mesothelioma usually gives pleural effusion and/or pleural thickening.

    19. Dr Pepe says:

      I selected this case to talk about the anterior clear space in the lateral view. Plus to test your “satisfaction of search”. If you look carefully, there are at least two additinal posterior pleural bumps in the lateral view(congratulations to Gus and J.D.). The most likely diagnosis are myeloma or metastases.
      Full answer tomorrow.

    20. Carlo says:

      GREAT Magister!!