Patient Data
The PA radiograph shows a large left mid zone mass which can be localized to the posterior of the chest by using the silhouette sign. The left heart border remains visible indicating that the mass cannot be anterior. Some of the left hilar vessels remain visible (hilum overlay sign) indicating that the mass is not centered at the hilum. The mass therefore must be located posteriorly within the apical portion of the left lower lobe. This is confirmed on the lateral radiograph.
Large left lower lobe mass is present, with narrowing of the left lower lobe main bronchus and artery.
Case Discussion
Large cancer with the apical portion of the left lower lobe. Nice example of how the silhouette sign and hilum overlay sign can help localize a chest lesion on a frontal projection alone.
Cytology:
Bronchial washings left lower lobe - malignant cells originating from a non-small cell carcinoma, best seen in the bronchial brushings from the left lower lobe, where the cytomorphology is suggestive of adenocarcinoma.
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