Dr. Pepe’s Diploma Casebook: Case 90 – SOLVED!


Dear Friends,


I am back with a new case, provided by my good friends Paula García and Alberto Villanueva. Images belong to a 52-year-old man with a dry cough. Operated on for cutaneous melanoma ten years earlier. Check the images below, leave us your thoughts in the comments section and come back on Friday for the answer.

1. Tuberculosis
2. Metastases
3. Varicella pneumonia
4. Any of the above



Click here for the answer

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    10 Responses to : Dr. Pepe’s Diploma Casebook: Case 90 – SOLVED!

    1. Borsuk says:

      There is diffuse reticular interstitial opacification. With pasy history I suppose lymphangitis carcinomatosis.
      So answer 2.
      In right axillary region are some vessel clips after surgery lymph node resection?

    2. Mahmoud says:

      There is air space opacity in left mid lung zone silhouetting part of left heart border,likely representing consolidation/ collapse in lingula lobe, it is also surrounded by focal area of reticulonodular pattern ,so from choices above,tuberculosis is most likely.

    3. Mohamed A.Aziz says:

      Lymphangitis Carcinomatosa

    4. sht says:

      If a single answer was required it would be lymphangitis carcinometosa.
      However, the pleural tags, diaphragm tenting, ?fibrosis left mid zone make TB a probability.
      Miliary is possible in varicella, as well as initerstitial features.
      So I will have to go with any of the above.

    5. genchi bari italia says:

      …non tbc….non esiti di polmonite varicellosa( anamnesi positiva per pregressa varicella?)….KISS regola: linfangite carcinomatosa….

    6. Jose Caceres says:

      I feel proud of the five brave radiologists that answered this case. The patient has a miliary pattern, that can be caused by TB, metastases and varicella. Therefore, the correct answer is 4. Any of the above. First prize goes to sht, who agrees with me.
      If you think this case is difficult, wait for the next one!

    7. genchi bari italia says:

      .,.,grazie grande PROF.