Dr. Pepe’s Diploma Casebook: Case 76 – SOLVED!

Diploma_casebook_case76

Dear Friends,

Only three more cases until summer vacation! Present images belong to a 58-year-old man with fever and malaise. Patient is allergic to contrast media. Have a look at the images below, leave your thoughts in the comments section, and come back on Friday for the answer.

Diagnosis:

1. Esophageal leiomyoma
2. Duplication cyst
3. Aortic aneurysm
4. Any of the above


Q1

Q2

Q3

Click here for the answer

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    24 Responses to : Dr. Pepe’s Diploma Casebook: Case 76 – SOLVED!

    1. gus says:

      I say any of the above.
      I think is difficult with out contrast to see the difference.
      Especially if we cant see the rest of the CT slides.

    2. murzin says:

      Actually it’s a secret option 5. Vagus nerve schwannoma

    3. akrzywda says:

      In my opinion the correct answer is esophageal leiomyoma.

    4. Kerrya says:

      May be mycotic aneurysm.

    5. genchi bari italia says:

      …la sede….le caratteristiche UH….la vicinanza senza piano di clivaggio, con la vicina aorta,,,,propendono x un aneurisma dell’aorta discendente

    6. Fares says:

      If the patient is allergeic to contrast, we can do MRI thorax instead.
      4. Any of the above

    7. centro de imagenes says:

      Para nosotros , no es un aneurisma aortico porque en la TAC se puede ver el calcio intimal que no demuestra que este dilatada.
      En cuando a un leiomioma esofágico, llama la atención que no presente síntomas de disfagia.
      Por lo que la imagen retrocardíaca en el perfil de tórax y para aortico en la TAC podría corresponder a un quiste de duplicación esofágico.
      Y la fiebre puede ser por una complicación del mismo.

    8. genchi bari italia says:

      …quella è la sede anatomica della v. azygos, che potrebbe essere dilatata, per disturbi di canalizzazione della VCI…

    9. tp says:

      esophageal leiomyoma

    10. Yvette says:

      The most probable – duplication cyst ( smooth shaped ,below carina, more often on the right side, in CT it shouldn’t be always fluid density, it can be soft tissue density ). Clinical symptoms due to bronchi compression, or infection itself. Differential diagnosis
      in MRI.

    11. Sherif says:

      Any of the above

    12. case ipad says:

      thank you for case

    13. Dr. Pepe says:

      Before posting the answer I want to thank you all for participating. The correct answer is saccular aneurysm. I honestly believe that the diagnosis cannot be made without contrast enhancement. Therefore, the best answer is 4. Any of the above.
      Congratulations to Gus who was the first one.

    14. genchi bari italia says:

      ….la probabile diagnosi puo’ pero’ essere avanzata sulla base delle caratteristiche TD, di base( UH identica a quella del lume aortico) e “mancanza” del piano di clivaggio con l’aorta….pertanto l’ipotesi diagnostica esatta è la 3….la 4 , per definizione , ha escluso l’ipotesi di un aneurisma che è invece indicata dal dott. Pepe….La Iuve sarà dura per il Barca, come io in questo caso….Saluti da Bari….

      • Dr. Pepe says:

        Dear friend, a native Englishman pointed to me that “Any of the above” included any of the possibilities offered. Therefore, aortic aneurysm is not excluded in the option nº 4.
        Hope we see a good match on Saturday and Barça wins!

    15. genchi bari italia says:

      ….carissimo e mitico professore….la palla è rotonda ed anche senza m.d.c si puo’ vincere la partita….saluti anche a lorenzo Bonomo altro mio caro maestro ed amico…

    16. Dr butt says:

      Post mediastinum soft tissue density lesion In right side of mediastinum with indistinct phase with aorta. Further evaluation with endoscopic USG.

    17. Baroth says:

      any of above

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