Dr. Pepe’s Diploma Casebook: Case 16 – SOLVED!

Dear Friends,

I am taking a short break and will not post a case during the Christmas week. The next case will be posted on December 31st. In the meantime, I am presenting the chest radiographs of a 56-year-old man who came to the emergency room with chest pain and low-grade fever. He had a fracture of T-8 ten years ago.

Fig. 1

Fig. 2

Most likely diagnosis:

1. Carcinoma of the lung
2. Pneumonia
3. Tuberculosis
4. None of the above

Click here for the answer

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    13 Responses to : Dr. Pepe’s Diploma Casebook: Case 16 – SOLVED!

    1. Alice says:

      left ul atelectasis highly suspicious of carcinoma until proven otherwise

    2. Genchi Bari Italia says:

      Perdita di volume dell’emitorace sx, ipoespanso, con riduzione degli spai intercostali, attrazione omolaterale dell’ombra cardio-mediastinica, opacità a banda retrosternale, pinzettamento pleurico basale , il tutto come da atetelettasia del bronco lobare superiore sx. Regola KISS : ipotesi piu’ probabile , CR bronchiale.

    3. carlo says:

      LUL collapse (atelectasis).
      Dense nodular opacity on left paratracheal stripe(left pilmonary artery with left bronchus in upper position?)
      Pleural calcification in left (and Right apex) and calcfication also in left middle field.

      Bronchial TB(i.e. Broncholithiasis).
      it’s a good idea?

    4. maria says:

      I believe this is a case of malignancy that have been left untreated . That fracture ten years ago was pathologic and now there is blured anterior border of T10 vertebra and increased intensity at the left axilliary region, which maybe has to do with the non visualization of the medial part of left scapula. So i will go with thoracic wall malignancy. the finding in the lungs are secondary perhaps due to meta.

      • Dr. Pepe says:

        Fracture of T-8 was traumatic, with fracture of right humerus as well. It would be unusual for a bone malignancy to last for ten years. I mentioned the previous fracture of T-8 to avoid misleading the readers.
        Try again.

    5. Stelios says:

      elevation of the diaphragm, nodular opacity ..I would go with the TB but CT is needed..

    6. Dr Hesham says:

      Lung ca

    7. Maria says:

      Shift of mediastinum towards left , left hilum enlargement and a pulmonary nodule that maybe have cavity . Reactivation of TB?

    8. RadLex says:

      There is volume loss on the left as evidenced by loss of the left cardiac border, mediastinal shift to the left, crowding of the left lower ribs and elevation of the left hemi-diaphragm. There is air-space shadowing in the lingula. A calcified lymph node is seen at the level of the carina, which is adjacent to and causing compression of the left main bronchus.
      There is loss of height of the T8 vertebral body in keeping with the known old fracture.
      I think this is reactivation TB with left bronchial stenosis and mucoid impaction leading to left lung collapse

    9. Genchi Bari Italia says:

      Caro dr Pepe, il Professor Caceres è più generoso un elogi di te: dimmi che sono stato bravo, anche se il caso era semplice! Con affetto dal Sud Italia.

    10. Dr. Pepe says:

      Yes I believe you are doing very well, both in the diploma and Caceres’ corner. Thinking of giving away T-shirts with Dr. Pepe’s picture to the best achievers. That’s much better than a compliment!

    11. Laura says:

      Hello! What’s the KISS method about? 🙂 thank you!