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Left lower lobe collapse

Case contributed by: Dr Amit Tripathi

Presentation:

Cough.

Patient Data:

Age: Adult
Race: Caucasian

CXR

Modality: X-ray

This initial CXR,  demonstrates a mass with lobulated contour is projected over left hilar shadow. Note that the hilar vessels are visible through the mass. This constitutes the 'hilum overlay sign' and indicates that the mass is not in anatomical contact with the hilum of left lung (although loosely, we still call it a 'left hilar mass' in day to day reporting!)

CXR few weeks later

Modality: X-ray

Progressive left lower lobe collapse as the cancer causes stenosis of LLL bronchus. There are associated signs of volume loss in left lower chest

CXR few weeks later still

Modality: X-ray

Further progressive left lower lobe collapse as the cancer causes stenosis of LLL bronchus. The lobe is completely collapsed and is hard to see, other than as loss of the outline of the descending aorta. There are associated signs of volume loss in left lower chest.

Case Discussion:

This series of chest films quite nicely demonstrate progressive left lower lobe lung collapse due to bronchostenotic cancer and shows how when collapse is complete, it is secondary signs (volume loss) which provide the clue to the diagnosis. 

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