Dr. Pepe’s Diploma Casebook: Case 96 – A painless approach to interpretation (Chapter 3) – SOLVED!


Dear Friends,

I hope you remember the three questions to ask when facing a chest radiograph:

a) Is there any visible abnormality? (Chapter 1)
b) Is it intra or extrapulmonary? (Chapter 2)
c) What does it look like?

To discuss the third question, I’m showing chest radiographs of a 36-year-old woman with chest pain.

What does the lesion look like?

1. Pericardial fat pad
2. Thymic tumour
3. Pericardial cyst
4. Any of the above

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



Click here for the answer

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    10 Responses to : Dr. Pepe’s Diploma Casebook: Case 96 – A painless approach to interpretation (Chapter 3) – SOLVED!

    1. panagiotis says:

      Hi, have a nice week.

      4. Any of the above-Differential diagnosis of right cardiophrenic angle mass

      CT to differentiate fat vs fluid vs solid component, for example

      Fat (pericardial fat pad, lipoma, thymolipoma, liposarcoma usually in posterior mediastinum)
      Fluid (pericardial cyst)
      Solid (thymoma, lymphoma)

    2. MK says:

      The PA view shows a paracardiac right increased density (silhouette sign) with an hilum overlay sign, that we can locate anterior in the lateral view. In this proyection the retrosternal space is obliterated. We have a thickening of the right paratracheal line but it will be secundary to scoliosis with dorsal right convexity is seen in the PA view.

      I think that it is an anterior mediastinum mass (diferential diagnosis in this case would be: lymphoma, pericardial cyst, teratoma).

    3. UFTM radiogroup says:

      Dear professor, in PA view we see a lesion with undefined margins but with hilum overlay sign, which may correspond an anterior or posterior origin. Also cardiac silhouette is obliterated. In lateral view we cannot say there is a posterior lesion. So, we think it`s anterior. It could be any of the options given: Pericardial fat pad; Thymic tumour; Pericardial cyst

    4. Mahmoud says:

      It looks like right middle lobe collapse.
      Of differential listed above, pericardial fat pad is most likely as it has ill define margin.
      Both thymus tumor and pericardial cyst should have well defined margin which is not the case here.

    5. Hemanth says:

      A fairly well defined smooth opacity is seen obscuring the right heart border with broad base towards the mediastinum. Vessels are seen through the mass s/o Anterior mediastinal mass.
      DD: Pleuropericardial cyst,Pericardial fat pad.

    6. genchi bari italia says:

      ….l’opacità sembra del mediastino antero-inferiore: cisti peluro-pericardica.

      • Dr Pepe says:

        Do you think that cyst is the only cause?
        Greetings from Lisbon

        • Genchi Bari italia says:

          ….ritorno venoso anomalo parziale…s. Della scimitarr? Ma il polmone non è’ ipogenetico…..Lisboa è’ romantica …prof.,…attento….!

    7. Dr Pepe says:

      Correct answer is 4. Any of the above. More information tomorrow.
      Congratulations to Panagiotis, MK and UFTM radiogroup, in that order.

    8. […] looked at the three key questions to ask when facing a chest radiograph (chapters 1, 2 and 3), we move on to the interpretation of pulmonary […]