Case 16 AnswerSo this may have been a little difficult without the ability to window/level but there are 2 findings here: 1) obscuration of...

Case 16 Answer

So this may have been a little difficult without the ability to window/level but there are 2 findings here: 1) obscuration of the right heart border and 2) hilum overlay sign (which was the attempted learning point).

Hilum overlay sign is an appearance on frontal chest radiographs of patients with a mass projected at the level of the hilum which is in fact either anterior or posterior to the hilum. So despite seeing a mass “overlying” the hilum you can still see vessels coursing through it, ie you can still see the hilum

http://radiopaedia.org/articles/hilum-overlay-sign

This is in contrast to the hilar convergence sign which shows the hilar vessels converging to the mass but not extending in front or behind it.

http://radiopaedia.org/articles/hilum-convergence-sign

So did we do a CT? you know we did.

Diagnosis: Pericardial cyst