Bronchogenic carcinoma with left atrial large deposit - T4N3M1a

Case contributed by Dr Mohammad A. ElBeialy

Presentation

Chest pain, cough and hemoptysis. Echocardiography showed a left atrial mass lesion. Past medical history of pulmonary tuberculosis with medical treatment.

Patient Data

Age: 60 years
Gender: Male
  • Left perihilar mass lesion with associated left upper lobe collapse as well as enlarged bilateral hilar and posterior mediastinal lymph nodes.
  • Large marginally enhancing hypodense lesion almost filling the entire left atrium, measuring 8.5 x 6.2 cm in its maximal axial dimensions. The lesion seems to narrow the left ventricular outflow tract.
  • Subsegmental consolidation with miliary nodules and tree-in-bud appearance scattered in the posterior and lateral segments of the lower lobes (RLL, LLL), as well as the right middle (RML) and upper lobes (RUL). These are probably metastatic deposits (M1a).
  • Right upper lobe (RUL) apical segment fibrocalcific scarring with reticulonodular infiltration and subpleural bullae consistent with probably old granulomatous infection.
  • The upper abdomen is unremarkable. No overtly destructive bony lesion.

Case Discussion

The above-described findings are those of left perihilar bronchogenic carcinoma with metastatic lymphadenopathy and a large deposit in the left atrium.  The tumor is staged as cT4 N3 M1a

The differential diagnosis of the left atrial mass lesion is atrial thrombus and, less likely, myxoma.

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