Dr. Pepe’s Diploma Casebook: Case 80 – SOLVED


Dear Friends,

Presenting chest radiographs of an 80-year-old man. Images were taken 24 hours after embolisation of hepatic metastases. What do you see?

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



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    11 Responses to : Dr. Pepe’s Diploma Casebook: Case 80 – SOLVED

    1. aloria says:

      gallbladder wall pneumatosis et pneumoperitoneum

    2. Ryan says:

      Emphysematous cholecystitis with perforation causing pneumoperitoneum.
      Sclerotic change on left first anterior rib. Hilar adenopathy.

    3. genchi bari italia says:

      …dopo TACE, si possono avere complicazioni….una di esse è legata alla ischemia prodotta dal materiale embolizzante , negli organi del tripode celiaco per un meccanismo di trasporto “retrogrado”….tra le strutture interessate vi è la colecisti e lo stomaco….una sofferenza ischemica può portare ad una colecistite e/o gastrite enfisematosa, con successiva perforazione e pn-peritoneo…in questo caso vi è inoltre una piccola falda di liquido nel seno costo-frenico….

    4. moises botello moreno says:

      Les agradesco por su pagina y por los caso son de gran ayuda saludos des de mexico gracias

    5. Borsuk says:

      Infarction of gallbladder with emphysematous cholecystytis and perforation with pneumoperitoneum as a complication of non intended embolization of cystis artery.

    6. J says:

      Apart from emphysematous cholecystitys and pneumoperitoneum all of you mentioned, I see (not sure, as always):
      -Bilateral linear interstitial pattern, more pronounced in bases. With clinical history of malignancy could be related to carcinomatous lymphangitis (compare with previous x-ray would help).
      -Small bilateral pleural effusion without cardiomegaly.
      -Distended colon, ¿obstruction?.

      • Dr. Pepe says:

        I believe the increased markings are due to difficult breathing. There was no colonic obstruction. Dilatation was probably secondary to mesenteric emboli or general distress. An autopsy was not done.

    7. Yvette says:

      There is an air in the gallbladder wall and in peritoneum, and probably also pneumobilia.In the chest there are signs of interstitial thickening,also spaces along bronchi and vessels ,volume of RLL is reduced – downward replacement of small fissure and right hilum. Acording to initial diagnosis it sugest hilar metastases and lymphangitis.
      Small amount of fluid in both pleural cavities.

    8. Dr. Pepe says:

      I am very proud of all of you. 100% correct diagnosis, led by Dr. Aloria.
      Beware of case 81, next Monday. It is going to be more difficult,

    9. genchi bari italia says:

      …quando il gioco si fa duro …… i duri iniziano a giocare….