Dr. Pepe’s Diploma Casebook: Case 70 – SOLVED!


Dear Friends,

Today I am showing chest radiographs of a 34-year-old male with dyspnea. Check the images below, leave your diagnosis in the comements section and come back on Friday for the answer.


1. Mitral disease
2. Pulmonary arterial hypertension
3. Interstitial pneumonia
4. None of the above



Click here for the answer

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    Feb 2015
    DISCUSSION 18 Comments

    18 Responses to : Dr. Pepe’s Diploma Casebook: Case 70 – SOLVED!

    1. murzin says:


      I think We can see here increased vasculature with moderate hilar vessels dilation but without amputation (characteristic for pulmonary artery hypertension). Vessels seem to be also superiorized.
      This would suggest congestive problem ergo mitral stenosis.
      On the PA view left atrium might be enlarged- on the lateral view also but would be better visualized with oral barium swallow technique.
      Pateient is young so he probably has good compensation mechanism and that is why We don’t see any pleural fluid or apparent edema (interstitial)

    2. genchi Bari Italia says:

      …non ci sono i segni della IP…..una forma di pneunopatia di tipo interstiziale e’ un miraggio con l’ rx- tradizionale( HR-tac)….e’ invece compatibile con una cardiopatia mitralica, ancora compensata….lieve congestione ilare vascolare , con iniziale ridistribuzione del flusso in senso caudo-craniale e presenza di ‘ doppio’ contorno sul profilo cardiaco di dx, come da mega orecchietta mitralica…..se poi, ricordandoci che siamo ‘anche’ clinici, sappiamo che ci sono soffi alla auscultazione cardiaca e conosciamo i risultati della eco-cardiaca, la diagnosi si completa….il Bari un disastro in campionato….come il REAL( godono i blu grana?)….

    3. J.D. says:

      Straightening of left heart border and double density of right heart border imply LA enlargement. Enlarged pulmonary vessels with cephalisation.
      Overall features are of pulmonary venous hypertension. Cause is Mitral stenosis or myxoma in Left heart.
      Faint round opacity over the left ventricle region seen on both frontal and lateral projection suggests presence of (partially calcified) myxoma.
      LV myxoma complicated by pulmonary venous HT.
      For echocardiogram and MRI cardiac.

    4. Moustafa says:

      Evidence of left paratracheal opacity seen more obvious in lateral film, suggestive of LUL consolidation…supported by mild upward shifting of the left hilum…prominent both hilar shadows with bilateral peribronchial cuffing…thinking of Sacroidosis, yet could not explain the enlarged left atrium causing cardiac double contour…Vote for 4

    5. gus says:

      1. Mitral disease

    6. maged says:

      pul hypertension

    7. manolis says:

      double shadow of the lower right heart shadow, superior displecment of the lift main bronchus. calcificasion of the anulus of mitral valve. The findings suggest for mitral gesease

    8. Greg says:

      Pulmonary arterial hypertension secondary to mitral stenosis 🙂

    9. elsa says:

      Enlarged pulmonary vessels and double contourn of the right hearth border like as LA enlargement, maybe some calcifications on lateral view overlapping hearth shadow..vote for 1.

    10. Nicky says:

      Mitral valve disease

    11. armando says:

      dilatation of the left atrium in keeping with mitral valve disease (stenosis)

    12. Carolina says:

      Mitral disease

    13. paulo granero says:

      Mitral stenosis
      Double contour of loft atrium

    14. Carmen Polidura says:

      Mitral disease

    15. Loles says:

      Mitral stenosis

    16. Dr. Pepe says:

      Congatulations to all of you. Mitral disease is the right diagnosis. This case is presented to discuss vascular redistribution. More information tomorrow.

    17. Dr T says:

      Diagknowsis: I think the photograph was of painting done in the 18th century. The artist tried to draw the inside of a very tensed dude using charcoal. This dude whose insides were drawn should be suggested to chill out.