Presentation
Fever, productive cough, shortness of breath. Known bronchogenic tumour.
Patient Data
Golden S sign of the right upper lobe (RUL) - right hilar mass with collapsed RUL.
RUL totally collapsed due to obstructed bronchus to RUL, with numerous small air-filled cavities which likely represent bronchiectasis. Cavitation at the centre of the lobe measuring 51 mm across, with air-high density fluid level.
Moderate right hilar and right mediastinal lymphadenopathy.
Calcified right and left coronary arteries (RCA, LMCA, LAD, and several of its diagonals).
Mild hepatomegaly.
Long-standing pneumobilia. Splenomegaly.
Erect chest radiograph taken exactly 2 years previously:
Irregular focal opacity with indistinct borders in the upper field of the right lung.
No hilar or mediastinal widening.
Coronal oblique MIP reconstruction of earlier chest CT demonstrates an irregular mass in the RUL.
Case Discussion
Patient presented with a productive cough and fever. He probably neglected to seek treatment for his malignancy due to psychosocial circumstances.
Labs: No leucocytosis, C-reactive protein 127 mg/l.
Cavitation at newer chest CT more likely due to exuberant infection rather than cavitary carcinoma, since it exhibits a thin rim.
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