Presentation
Presents from GP with worsening SOB and hemoptysis, 50 pack year smoking history.
Patient Data
Veiling opacity in the left hemithorax extending outwards from the hilum and obscuring the left heart border with associated volume loss and elevation of the left hemidiaphragm, consistent with left upper lobe collapse. The right lung and pleural spaces are clear. Flattening of the right hemidaphragm suggests underlying obstructing airways disease.
A large, central hypodense mass with a dependant locule of gas is obstructing the left upper lobe bronchus and resulting in complete left upper lobe collapse. Associated left loculated pleural effusion. Paraseptal emphysematous changes at the lung apices.
Case Discussion
Subsequent CT-guided chest biopsy was performed which revealed squamous cell carcinoma. This is a nice example of left upper lobe collapse due to a large obstructing bronchogenic carcinoma (SCC). The aortic knuckle remains visible due to the interposition of the apical segment of the left lower lobe between the collapsed left upper lobe and mediastinum, the so-called Luftsichel sign.