Complete bronchial obstruction

Case contributed by Dr Paul Simkin

Presentation

Testicular cancer with known pulmonary metastases. Routine follow up.

Patient Data

Age: 35
Gender: Male
Modality: X-ray

Complete white out of the right hemithorax, with mild deviation of the trachea to the right. A subtle endoluminal mass is appreciable extending from the right main bronchus into the lower trachea just above the carina.

The left lung is normal. No osseous destruction.

Modality: CT

Complete obstruction of the right main bronchus from the level of the carina by a soft tissue density within the lumen. The trachea is deviated to the right. Subsequent collapse of the right lung with right hemithorax volume loss. The right lower lobe is "drowned" with prominent mucous plugging, however, patent pulmonary veins and arteries. The right upper lobe pulmonary artery is truncated with reduced perfusion to the right upper lobe. Impression of multiple right sided pulmonary metastases - difficult to clearly delineate amongst collapsed lung. A 2.8 x 2.1 x 5.4 cm,  right paratracheal lymph node is noted.The left lung is clear.

Conclusion:

Obstruction of the right main bronchus by a soft tissue mass resulting in airless "drowned" right lung with subsequent volume loss and mediastinal shift. Impression of multiple pulmonary metastases. Right paratracheal lymphadenopathy. Right pleural effusion.

Case Discussion

When looking at a case of complete hemithorax white-out, the position of the trachea is used to determine positive or negative mass effect, and hence indicate possible causes. 

In this case there is complete right lung collapse seen on the CT, but the degree of deviation is less than expected as the presence of a pleural effusion "balances" the mass effect to an extent.

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Case Information

rID: 33097
Case created: 31st Dec 2014
Last edited: 17th Dec 2015
System: Chest
Inclusion in quiz mode: Included

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