Presentation
Respiratory failure
Patient Data
Large mediastinal nodules/masses, including subcarinal. There is nodular pleural thickening on the right with a large effusion (HU 10), possibly loculated. The right middle and lower lobes are collapsed. There is marked narrowing of the lobar and segmental bronchi on the right, due to filling defect.
Atelectasis within the left lung also demonstrated. There are subcentimeter nodular opacities within the left lung. A region of calcification adjacent to the left lower lobe bronchus is associated with a nodule that measures 22 x 22 mm. No pericardial effusion. A right paratracheal lymph node measures 17 x 14 mm.
Compression fracture of the T11 vertebral body with approx 50% height loss, age indeterminate. Old healed right rib fracture. No suspicious bone lesion.
Within the limitations of this study, the visualized upper abdominal viscera are unremarkable, although there appears to be atrophy of the left kidney.
Conclusion
Nodular pleural thickening on the right with large effusion. Right middle and lower lobe collapse. Comparison with previous imaging in the first instance suggested.
Case Discussion
Right pleural tap was performed.
Cytology: carcinoma with neuroendocrine differentiation; the features favor a large cell neuroendocrine carcinoma.
Acknowledgment: Dr James Sheldon.
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