Dr. Pepe’s Diploma Casebook: Case 75 – SOLVED!


Dear Friends,

Today I am showing radiographs of a 48-year-old woman, native of Central America, with endometrial carcinoma. Check the images below, leave your thoughts in the comments section, and come back on Friday for the answer.

1. Lung metastases
2. Pneumonia
3. Parasitic disease
4. None of the above



Click here for the answer

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    22 Responses to : Dr. Pepe’s Diploma Casebook: Case 75 – SOLVED!

    1. murzin says:

      NF2- interstingly confined to the left side in majority.

    2. Lola la Piconera says:

      4. Left mastectomy. Pony tail towards the left side?

    3. gus says:

      Left mastectomy.Breast cancer recurrence? parasternal und supraclavicular nodes?

    4. aloria says:

      left upper lobe consolidation.

    5. Borsuk says:

      A patient is post left mastectomy and there are supra and infraclavicular nodes outside lung on left side. I suppose reccurence of breast cancer in metastatic lymphadenopathy.

    6. genchi bari italia says:

      ..contro l’ombra cardiaca , in basso, a sx, si proietta opacità ovalare, a margini netti, con alcuni inclusi più rx-opachi( cutanea ?)….immagine osteosclerotica, sul margine anteriore della 5 costa sx…in LL formazione rx-opaca all’interno dell’apparato gastrointestinale….

    7. Andres Roca says:

      Saludos Dr. Pepe!!! Veo una imagen nodular silueteada con el mediastinicos superior a nivel derecho y prominencia del hilio izquierdo, veo que no hay la mama derecha tampoco así que me voy por la numero 4 creo son ganglios metástasicos

    8. Ryan Tee says:

      In my opinion, there are multiple osteosclerotic lesions in the ribs.
      As mentioned, there is also loss of left breast tissue, suggesting left mastectomy.
      There are also retrocardiac opacities but im not sure what are those.
      The gastric bubbles are abnormally large and is displaced near to heart suggesting maybe splenomegaly secondary to mets or gastric outlet obstruction?
      In lateral view, there is lymphadenopathy ‘doughnut sign’ surrounding the bronchus.

    9. hector says:

      Se observa incremento de la densidad de tejidos blandos superficiales en región cervicotoracica izquierda de aspecto linfoide agregando incremento de la anchura de la linea paramediastinal superior en la confluencia de la VCI las características sugieren una infección aguda asociada a enfermedades tropicales(leismaniasis, chavas etc)sin embargo por los antecedentes de CA se tendrían que caracterizar los ganglios.

    10. Sara says:

      Left Mastectomy – Left supraclavicular LN

    11. Yvette says:

      Lateral view without any special anomalies. On PA view there is an opacification along spine on the left side, it is visible in soft tissue above the ribs and also below the diaphragm. So it is in soft tissue or on the skin -braid of hair?
      I don’t think the lady is after mastectomy. There is a round opacification on the anterior part of the 5th rib – This is the left nipple, almost at the same level as the right, densities of both lungs are the same only the border is not so sharp as on the right.

    12. Andrei says:

      At first, after looking on the PA view, I would’ve considered those nodular opacities to be most likely lung metastases associated with lymphadenopathy (in the mediastinum and laterocervical). But when I saw the lateral view, I know they aren’t in the lungs at all, but in the superficial soft tissues. In my opinion, they seem to indicate most likely a congenital condition, which obviously includes benign soft tissue tumours, like neurofibromatosis. I’m looking forward to see more investigations or clues. I would like to add that this post showed me once again the importance of chest lateral views.

    13. Al mais says:

      left mastectomy

    14. Osama says:

      ? lymphangitis carcinomatosa

    15. gus says:

      ok endometrial carcinoma metastatic L.nodes

    16. Dr. Pepe says:

      As this time of the day, I can give you the right answer: braided hair.
      This is important case, because hair and other artifacts may simulate other pathologies. At least to a few of you!

      Congratulations to Lola la Piconera and Yvette.

    17. gus says:

      She is from matsu picchu no? 🙂
      now is obvious!!!!

    18. Baroth says:

      4. non of above