Dr. Pepe’s Diploma Casebook: Case 69 – SOLVED!

Diploma_casebook_case69

Dear Friends,

Today I am showing radiographs of a 61-year-old woman who underwent surgery for ovarian carcinoma three years ago.
Examine the images below, leave your diagnosis in the comments section and come back on Friday for the answer.

Diagnosis:
1. Carcinoma of the lung
2. Metastases
3. Tuberculosis
4. None of the above


Q1

Q2

Click here for the answer

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    19 Responses to : Dr. Pepe’s Diploma Casebook: Case 69 – SOLVED!

    1. gus says:

      – there is complete radiopacity of the right lung with out shifting to the left or to the right of mediastinum (pleural efiusion – collaps))
      – swelling of the right hilum
      – pulmonary nodes on the left.
      that make me suspicious is that, i think i can see both diaphragms on the lateral view.
      my First choice is 2 Metastases

    2. kuba says:

      meigs syndrome

      • Florin says:

        Meigs syndrome disappear after ovary tumor resection and it is associated with begin ovary tumors.

        I agree with Gus’s description. Also there is an amputation of the right main bronchus. I cannot rule out a primary lung cancer protruding into right main bronchus with collapse and pleural effusion.

    3. Borsuk says:

      Gus clearly describe findings:)
      but I’m not sure that metastases could cut off bronchus like that.
      I think it’s probably carcinoma of the lung in right bronchi with metastases in left lung.

      • Dr. Pepe says:

        Any endobronchial lesion (metastases, carcinoid, etc.)
        may give the same appareance than a primary lung carcinoma. Of course, carcinomas are more frequent.

    4. genchi bari italia says:

      …..regola KISS….CR ovarico…..atelettasia polmone dx( da metastasi endbronchiale)….metastasi polmonari a sx…..

    5. genchi bari italia says:

      …grazie MITICO Professore, sopratutto per i meravigliosi insegnamenti !!!!!!!

    6. Moustafa says:

      I could not appreciate the right diaphragmatic copula in both PA and lat views, with rather homogenous opacification of the right hemithorax with cutting off the right main bronchus, and no shift of the mediastinum, for me concomitant right lung resection with the ovarian intervention is the reasonable clue, vote for 4!

    7. Fares says:

      A complete ‘white out’ of the right lung slight tracheal shift to the right. i think there is a lesion occluded the right main bronchus; TB? Tumour?FB?

    8. manolis says:

      complete obstruction of the right main bronchus as a bronchus ca

    9. Fares says:

      Endobronchial tuberculosis

    10. Dr. Pepe says:

      Late on Thursday I can tell that the diagnosis is enodbronchial metastases. More informationa baout endobronchial lesions tomorrow.
      Congratulations to Gus, who suggested the diagnosis a few hours after the case was posted.

    11. Carolina says:

      I Belive that the option 2 (metastases) Is right.

    12. elsa says:

      professor can you give me an hint about the kiss approach?

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