Presentation
Presentation to A+E with stridor. History of persistent cough (not responding to antibiotics) and 2 stone weight loss over three months. Also dysphonia and dysphagia to solids (one month). Current smoker. Large fixed level IV mass on left. On nasal endoscopy, fixed left cord and blood at piriform fossa. Normal CXR five months previously.
Patient Data
Bulky left hilum with left mid- and lower-airspace opacification.
Fullness in the superior mediastinum with significant tracheal deviation to the right.
Large mediastinal soft tissue mass (~13cm) extending into the left supraclavicular region. Superior mediastinal disease deviating trachea and esophagus to the right. Luminal narrowing within the trachea and proximal bronchi (5mm diameter at carina). Bulky mediastinal and left supraclavicular involvement.
Background emphysematous changes. Small left pleural effusion. 9mm soft tissue nodule in left upper lobe periphery. The SVC is patent although the azygos vein is narrowed.
Ill-defined low attenuated region in the right lobe of the liver (3cm). Heterogenous left adrenal mass (3.3cm). Gallstones, no other significant abdominal abnormality.
No destructive bony lesions.
Case Discussion
Pathology of the neck lump was consistent with metastatic small-cell carcinoma of the lung.
This gentleman was referred to oncology and unfortunately died three days after presentation.
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