Dr. Pepe’s Diploma Casebook: Case 89 – SOLVED!


Dear Friends,

This week we are presenting radiographs of a 42-year-old diabetic man with chest pain and fever. 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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    14 Responses to : Dr. Pepe’s Diploma Casebook: Case 89 – SOLVED!

    1. Olena says:

      Trachea and main bronchi without visible abnormalities.
      Following aortic contour without abnormalities.
      Lungs: the right lung is decreased in volume, there are increased vessel shadows and linear pattern due to peribronchovascular infiltration, on the level of the 3d rib there is shadow of horizontal fissure.
      in the left lung there is decreased lung attenuation mostly in upper and mid zones
      Right hila shows abnormal bronchial and vessels division
      There is mediastinum shadow enlargment suggesting hypertrophy of left ventricle, with smooth contours.
      There is elevation of right hemidiaphragm on the level of anterior part of 4/5 ribs

      On the lateral view – the darkening of the anterior mediastinum.

      Suggestion of right lower lobe hypoplasia

    2. Borsuk says:

      Obvious abnormality on this exam is elevation of right diaphragm. Minor fissure is in normal position. Where exactly is that pain?

      • Dr Pepe says:

        You don’t need to know where the pain is to make the diagnosis. Allow me to withold the information

    3. Aleksandar says:

      Beside above mentioned there is suspicious air collection underneath left hemidiaphragm.

    4. berti says:

      Is there some hyperlucency of the soft tissues near the left shoulder joint? Might there be some emphysema / abscess / septic arthritis?

    5. sht says:

      Is there a round soft opacity at the hilum?

    6. Jose Caceres says:

      No, to my knowledge

    7. genchi bari italia says:

      ….vi è un allargamento del profilo mediastinico, sopratutto nella linea paraspinale sx, con occupazione delle spazio chiaro retrosternale….di natura adenopatica….linfoma?

    8. Bujar says:

      At the left arm projection and subscapular,some areas of air density like subcutaneus emphysema.

    9. Bujar says:


      Very sorry,my english is little

    10. Jose Caceres says:

      At this time of the week I would like to congratulate Berti (Gold medal) and Bujar (Silver medal), as the two persons who saw the air over the shoulder. Last week’s case was similar and emphasized that we always should look at the corners of the film.
      More information tomorrow. Happy weekend!