Dr. Pepe’s Diploma Casebook: Case 72 – SOLVED!


Dear Friends,

Today I am presenting radiographs of a 51-year-old man with low-grade fever and malaise. Previous history of car accident.

Do you see any abnormalities?

Check the images below, leave your thoughts in the comments section and come back on Friday for the answer.



Click here for the answer

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    12 Responses to : Dr. Pepe’s Diploma Casebook: Case 72 – SOLVED!

    1. gus says:

      Hiatus hernia – bronchiectasis

    2. Ana Villanueva says:

      Hay dos cosas que me llaman la atención. En la lateral no veo bien el espacio claro anterior y en la Pa las líneas mediastinicas (además de por la hernia) no me parecen normales.
      El accidente es reciente?

      • Dr. Pepe says:

        Tu apreciación del espacio claro anterior es correcta: no se ve bien.
        El accidente ocurrió hace siete años.

    3. genchi bari italia says:

      …ernia traumatica diaframmatica anteriore dx, a contenuto epato-omentale….chiave di lettura:non si vede in tutto il suo decorso , il profilo diaframmatico anteriore dx in LL e la pseudolobulazione della cupola diaframmatica dx in AP…Con stima …..

    4. gus says:

      Sorry professor. let me try again
      enlargment of heart size prominent pulmonary vessels
      On the lateral view along of the frontal borders of the heart on the sub sternal space its a band like radiopacity.
      ( pericardium thickening ?)
      it a long time from the accident and i can’t see fat pad sign or calcifications. hot or cold? 🙂

    5. stanko says:

      I couldn’t tell anything special about these images, maybe two theories.
      1. Could it be some kind of encapsulation of lung contusion, or something similar (looks to me like a small consolidation in the left lower field)
      2. Interstitial pneumonia 🙂

    6. Prasanna Kulkarni says:

      on lateral radiograph, there is loss of anterior heights of probably D7 and D10 vertebral bodies with ill definition of the superior endplates of the respective vertebrae. Mild reduction in disc height is seen at D9-10 level. Obliteration of the retrosternal lucency noted in the lower third region.

      On frontal radiograph a fusioform thoracoabdominal opacity is seen in the posterior mediastinum. Also an ill-defined haziness in seen in the periphery of the left lower zone, obscuring the cardiac apex.

      Unifying diagnosis in the setting of fever and malaise is tubercular osteomyelitis with paraspinal abscess. The lingular consolidation could point out to atypical mycobacterial infection.

    7. Mogila Alexander says:

      Clinoid deformation of IX thoracic vertabrae.

      Compresed. f raacture of vertebral body IX thoracic verthebrae.

    8. Andrei Miftode says:

      Post traumatic left diaphragm small intestinal herniation (post traumatic trough rib fracture ? / congenital ?).
      Left lower lobe early stage consolidation ( explaining the symptoms )maybe because of chronic passive atelectasis.
      Left anterior thickening of the pleura, most probably post-traumatic pahipleuritis.
      Was the impact left antero-lateral ?

    9. drwinnped says:

      Heart great vessels and rigt lung look normal
      Left heart and diafragma contour are not clear.
      I suspected from mucus impaction on lateral film
      My DDx: left lower lobe pneumonia/subsegmenter atelectasia