Bronchogenic carcinoma metastasis

Case contributed by Dr Hani Salam

Presentation

Altered mental status and headache of recent onset

Patient Data

Age: 60 years
Gender: Male

Large enhancing intra-axial mass of the right cerebrum with vasogenic oedema, midline shift, subfalcine herniation and effacement of the ipsilateral lateral ventricle. Primary brain malignancy vs metastasis.

CT head: large enhancing intra-axial mass of the right cerebrum with vasogenic oedema, midline shift, subfalcine herniation and effacement of the ipsilateral lateral ventricle. Primary brain malignancy vs metastasis.

CTPA: lung mass centred on the superior segment of the left lower lobe, with invasion through the oblique fissure into the upper lobe, and also into the mediastinum. Centrilobular and paraseptal emphysema. Mass is suspicious for a primary bronchogenic carcinoma.

X-ray

High suspicion for a bronchogenic carcinoma of the left upper zone.

Case Discussion

CT of the brain performed on-call revealed an enhancing intra-axial lesion. The possibility of a primary brain lesion was entertained. Given the patient's age, glioblastoma multiforme (GBM) was the primary consideration.

Brain MRI was performed the next day, and the differential diagnosis did not change, with GBM remaining high on the list.

The patient developed severe shortness of breath, and a CTPA was performed and revealed no PE, however, a large mass was noted. This was pathologically-proven to be a bronchogenic carcinoma.

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Case information

rID: 9286
Published: 29th Mar 2010
Last edited: 15th Oct 2018
Inclusion in quiz mode: Included

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