José Vilar and Friends Case 9 (Update: Solution!)

Dr. Ramiro Hernandez

Hello my Friends.

Today I am presenting you with a case from my good friend Dr. Ramiro Hernandez from Ann Arbor University, Michigan.
He is a well-known pediatric radiologist and, as me, likes to extract good and useful information from plain films.

These radiographs belong to a one-year old child with suspected respiratory infection.

Let us see what you think…

Additional information:
After reading your smart comments, here is an ultrasound image. With this, you must make the diagnosis hopefully.

This time, come back on Monday to find the solution!

Click here for the answer

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    Apr 2019
    DISCUSSION 10 Comments

    10 Responses to : José Vilar and Friends Case 9 (Update: Solution!)

    1. Luka Flegar says:

      Morgagni’s hernie DD pericardial fat pad

    2. Mauro says:

      There is an abnormality of the diaphragmatic contour on the right medially, partially silhouetting the right heart border. It is well defined and has rounded contours. It likely represents a lesion which is extrapulmonary and could be arising from pleura, diaphragm or from underneath the diaphragm. Differential is broad and I would further investigate with an ultrasound in the first instance.
      It could represent a pleural neoplasm (pleuroblastoma?) or loculated effusion (less likely). It could also represent an abnormality of the diaphragm (defect with herniating liver?) or a liver tumor pushing the diaphragm upwards. Other differentials would be pericardial cyst, sequestration, congenital (foregut duplication) and acquired (hydatid) cysts.


      Partial eventration of diaphrgm with high liver.

    4. Rasha Abdelhafiz says:

      Well-circumscribed mass adjacent to right cardiac border with cardiac silhouette
      *Pericardial cyst
      *Morgagnia hernia
      *Pericardial fat pad

    5. Shukri says:

      11 pairs of ribs
      Eventration of diaphragm
      Mediastinum appears narrow. Status of thymus ?

    6. Pratiba says:

      Eventration of liver right hemithorax.

      • Pratiba says:

        Eventration of right hemi diaphragm with liver herniation into right hemithorax.

    7. nat bi says:

      cardiac rhabdomyoma? you cannot see the border of the left atrium on the xray and i think i can see the pericardiac fat shadow/border on the right at the frontal view. on u/s it looks solid- like and eterogenous (could be an amartoma)or maybe breast milk. i think it also correlates with the clinical context awaiting for the answer… thank you

    8. Humberto Rosas Lavado says: