Presentation
Chest pain, breath shortness, cough and haemoptysis.
Patient Data
The right lower lobe bronchus is occluded, and collapse consolidation of the right lower lobe is evident. A large ill-defined infiltrative mass encases the right hilar structures and extends into the adjacent mediastinum. After contrast medium administration, prominent vessels traverse an airless low attenuation portion of the consolidated lung (CT angiogram sign), and are displaced around a relatively hypovascular and lower attenuation area.
A few subcarinal and right paratracheal lymph nodes have a short axis diameter of up to 20 mm.
Mild mediastinal shift to the right.
There is a sizeable heterodense mass lesion at the medial margin of the right lung's lower lobe, extending to the mediastinum and subcarinal area. It involves the bronchovascular bundle of the lower lobe, leading to extensive peripheral atelectasis and collapse and showing intense FDG uptake (SUVmax=18.6).
The mediastinum has an enlarged lymph node with very intense FDG uptake (SUVmax=22.65) in the right upper paratracheal area. Another enlarged lymph node with similar characteristics is noted in the subcarina.
Case Discussion
The patient underwent a bronchoscopy and biopsy, and histopathology with IHC evaluation confirmed poorly differentiated non-small cell lung carcinoma, adenocarcinoma subtype.
This case demonstrates the CT angiogram sign that refers to normally enhancing pulmonary vessels appearing prominent on contrast-enhanced CT as they traverse an airless portion of the atelectatic lung. The atelectatic lung is hyperattenuating to skeletal muscle whereas the tumour is relatively hypoattenuating.
The CT angiogram sign can be seen in post-obstructive atelectasis, pneumonia, pulmonary oedema and malignancies such as lung adenocarcinoma, pulmonary lymphoma, and metastasis from gastrointestinal carcinoma.
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