Dr. Pepe’s Diploma Casebook: Case 74 – SOLVED!


Dear Friends,

Today I am showing PA radiographs of a 52-year-old man with cough and mild fever. Take a look at the images below, leave me your thoughts in the comments section and come back on Friday for the answer.

1. Inferior accesory fissure
2. RLL collapse
3. Pneumonia of medial RLL segment
4. None of the above



Click here for the answer

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    Apr 2015
    DISCUSSION 11 Comments

    11 Responses to : Dr. Pepe’s Diploma Casebook: Case 74 – SOLVED!

    1. Ryan Tee says:

      I think A inferior accessory fissure.

      RLL collapse is unlikely because there is no volume loss in right hemithorax.

      there is no loss of silhouette of the right heart border, therefore i think RLL pneumonia is not likely.

    2. Mahmoud zaki says:

      i think it is a LRL collapse

    3. Borsuk says:

      there is obvious fissure going from the right hilum to middle part of right diaphragm. Also there is increased lucency in most part of right lung. I suppose some overdistension of lung lobes with alteration of fissure.
      Maybe some chronic state?- RLL hipoplasia.
      Or partially collapse RLL- there could be (but I’m not so sure:) lost of medial part of diaphragm and poor visualization of descending right lower lobe pulmonary artery.

    4. gus says:

      I think there is a partial RLL collapse in combination with right inferior accesory fissure

      • gus says:

        – There is decreased right lung density
        – There is a triangular lung density adjacent to the right heart border without loss of clarity (no silhouette sign)
        – i think there is also blunting of the right costophrenic angle.

    5. yvette says:

      There is an overdistention of the RUL. Right hilum is poorly visible, no interlobar artery on the right site.
      There is no siluette sign so the RML colaps is excluded.
      It could be RLL colaps or some kind of RLL hypoplasia.

    6. genchi bari italia says:

      ….<<<<<<<<polmone iperlucente omolaterale o S.S.J McLeod

    7. Borsuk says:

      Excellent case!
      Thank you very much

    8. Dr. Pepe says:

      Want to congratulate those of you who mentioned the right diagnosis: Mahmoud zaki (first one),Borsuk, Gus (hesitating) and specially Ivette.