Dr. Pepe’s Diploma Casebook: Case 73 – SOLVED!


Dear Friends,

After mid-term vacation, I return with renewed energy! Presenting images of a 54-year-old man with a moderate cough.

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

1. Apical bulla with fungus ball
2. Carcinoma of the lung
3. TB and granuloma
4. None of the above


Click here for the answer

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    22 Responses to : Dr. Pepe’s Diploma Casebook: Case 73 – SOLVED!

    1. Borsuk says:

      there is nodular opacity in apex of right hilum connected with hyperlucency of upper part of right lung.
      I suppose it is bronchial atresia.
      I cannot explain clinical symptom -moderate cought- with radiologic findings.

    2. gus says:

      Opacity in the upper part of the right hilum with elevation of the hilum (lost of volume of the right upper lung) and hyperlucency in the upper right lung with a few visible vassels.
      i think a lateral view can give us more informations.
      My First choise is carcinoma because the age of the patient or carcinoid .
      Second choise mucoid impaction

    3. genchi bari italia says:

      …l’opacita ” a dito di guanto” rappresenta un broncocele riempito di secrezioni mucose….mentre l’iperdiafania circostante rapresenta ” l’air trapping” determinato dalla circolazione collaterale , attraverso i pori di Khon, degli adiacenti segmenti polmonari normo-ventilati….Saluti da BARI…..

    4. Nop says:

      There is hyperlucency around the well defined nodule in the right upper lung zone. In this area of lung lucency, number of lung marking is lessor than other part of the lungs. Bronchial atresia is suspected.

    5. Rusty says:

      Is there also a nodule at the left side, behind the heart apex? Or am I just hallucinating?

      • Rusty says:

        Or is that a monster nipple? 🙂

        • Rusty says:

          Regardless of my question. I will consider it a malignancy because of the elevation of the hilum. And I think there is no real lucency, it is caused because of the projection of scapula and rips.

          PS. Amazing, how old school Radiologist survived without CT. 🙂

          • Dr. Pepe says:

            I will take it as a compliment! I just discovered in the chest radiograph a lung nodule that was missed in two previous CTs.

      • Dr. Pepe says:

        Yes, you are.

    6. Tedi says:

      Apical bulla with fungus ball due to right mid-upper hyperlucency , splayed pulmonary vasculature and nodular opacity above right hilum. Also, elevation of right hilum. (small) left pleural effusion?

    7. Amr othman elsisy says:

      Right upper lung zone bulla ( devoid of lung markings) with right hilar opacity, likely nodal. TB is most likely

    8. ara says:

      Slight Right pleural effusion with intersticial parahiliar nodule that could be related to: 1. carcinoma vs 2. Carcinoid vs 3 hamartoma vs metastasis

    9. Marwin says:

      considerar aneurisma de rasmusen

    10. Dr Ramesh K Pandey says:

      Well lucency is there involving Rt lung parenchyma upper zone with visualization of vascular makings…soo no pneumothorax….Rt perihilar nodular opacity is there with tiny scattered calcification rt lower zone….will prefer TB more then malignancy….

    11. Dr Ramesh K Pandey says:

      Hmm…by the way what’s moderate cough???… Do we grade cough as mild, moderate n severe….:-):-):-)

    12. j.d. says:

      Right perihilar tubular like opacity with paucity of lung markings distally in the right upper zone. Overall features are of bronchial atresia with mucus impaction.

      Also blunting of right costophrenic recess and small opacity at the periphery of right lower zone with radiating reticulation towards it, representing pleural thickening and fibrosis. – think this is more of incidental finding.

    13. Dr. Pepe says:

      The correct diagnosis is bronchial atresia.
      Congratulations to Borsuk, who was the first to make the diagnosis.

    14. genchi bari italia says:

      ….complimenti anche al dott. GEnchi che ne ha descritto la semeiotica elementare ed il substrato anatomopatologico !LUNARE il Barca visto contro il Paris S. Germain!!!!

    15. […] Most are asymptomatic and are first discovered in the adult age. Some of them were reviewed in Dr. Pepe’s Diploma Casebook Case #73. One of the most common is hypogenetic right lung (scimitar syndrome), which gives the chest […]