José Vilar and Friends Case 49 (Additional data!)


Dear Friends,

This case was sent to me by Dr. Ana Villanueva, a young Spanish radiologist actually training at Sunnybrook Health Sciences Centre (Toronto).
Ana is a good representation of the new generation of radiologists. Her father, Dr. Alberto Villanueva has contributed to this blog (Case 31) and probably is partly responsible for Ana´s interest in thoracic Radiology.

This is a case from Sunnybrook Health Sciences Centre in Toronto, Canada
Dr Mohamed Saber and Assoc Prof Frank Gaillard et al.

Case 49:
16 year-old female

Reason for the study: history: cough, shortness of breath, right sided chest pain, fever x 3 days

Update: I’ll include CT and a PET/CT image.

Can you now think of possible diagnosis?

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    07
    Jun 2021
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    DISCUSSION 14 Comments

    14 Responses to : José Vilar and Friends Case 49 (Additional data!)

    1. Rea Laçi says:

      Right middle lobe pneumonia

    2. dr.k.kanakaraj says:

      x ray chest pa view and lateral views shows the following features;
      slight scoliosis upper dorsal region
      slightly vertical directed anterior ribs and slightly horizontal post end of ribs, depressed lower end of sternum with reduced ap diameter of chest in lateral view
      indistinct rt cardiac border, cardiac silhoutte pushed to left side.
      hyperventilated lung fields with wedge shaped opacity wit muliple small cystic space at right lower zone and cardiophrnic angle, spine sign in lateral view suggesting lower lobe pathology.
      medial breast margin sign on left side
      additional rib -lumbar rib on left side
      features of pectus excavatum, with mild scoliosis,lower lobe pneumonia with bronchiectatic changes, with rib anomaly

    3. Anomalie radiologique au níveau de D7 suggestive de spondilodiscite?

    4. Rosanna Meza says:

      Neumonía del lóbulo medio

    5. Gonzalo BM says:

      Mal de pott

    6. Agustina says:

      Right inferior lobe pneumonia

    7. Rafael says:

      Pectus excavatum mimics middle lobe pneumonia.Right inferior lobe pneumonia

    8. José Vilar says:

      Wow, many people have dared participate!.A couple of coments regarding your ideas:1) Yes there is a pectus excavatum that could mimic right lung pathology or even sometimes cardiac pathology, but this is not the important finding in case 49. 2) And no, the pathology is not in the middle lobe, (just look at the lateral), its posterior, Now a bit of help: can you identify a specific pattern in the right lower lobe pathology?

    9. Elena says:

      Mass (extrapulmonary?)lesion.
      Air fluid levels?

    10. Sofija says:

      There are some gas inclusions in the projection of right cardiophrenic angle? Maybe in the thoracic wall?

    11. Iliketurtles says:

      Round pneumonia RLL

    12. Sophie says:

      Necrotizing pneumonia of the right middle lobe

    13. Marcos Mestas Nuñez says:

      On the CT we confirmed what was evident on the lateral chest xray, the spine sign with some cystic areas in the right lower lobe.
      GIven the image characteristics (multicystic opacity) and the age of the patient my first diagnosis would be a superinfected CPAM (type I).
      There isn’t any arterial vessel coming from the aorta to suspect an associated pulmonary sequestration

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