Lung cancer

Case contributed by Sally Ayesa
Diagnosis certain


Dyspnea and cough with hemoptysis. Thoracic back pain.

Patient Data

Age: 80 years
Gender: Male

There is a large area of airspace opacification in the left mid-lower zone. There is silhouetting of the left heart border on the frontal projection, placing the abnormality in the lingula segments of the left upper lobe which is confirmed on the lateral projection. The oblique fissure appears lobulated. 

The right lung and pleural recesses appear clear. 


The abnormality on the chest x-ray corresponds to a large, heterogeneous mass lesion in the lingula segments of the left upper lobe. There is an abrupt cutoff of the lingula segmental bronchus consistent with endobronchial extension. Ground glass consolidation adjacent to the mass may relate to tumor infiltration or post obstructive change. 

The mass has broad pleural abutment against the chest wall, oblique fissure and pericardium. There are pushing margins against oblique fissure, with interlobular septal thickening and ground glass in the adjacent left lower lobe consistent with local invasion across the visceral pleura. Loss of the fat plain in the left 5th intercostal space suspicious for chest wall invasion. 

Contiguous heterogeneous soft tissue invading into the left superior pulmonary vein and into the left atrium (tumor thrombus). Additional focal thrombus in the right inferior pulmonary vein.

Bulky lymphadenopathy in the ipsilateral and contralateral hila and mediastinum. 

Pericardial effusion. Small left pleural effusion. 

No adrenal masses. Subcentimeter hypodensities in the liver are non-specific and too small to characterize. 

Case Discussion

Endobronchial biopsy-confirmed primary lung adenocarcinoma and he went on to systemic chemotherapy.

Based on imaging, the patient would be staged cT4N3M1a (Stage IVA). The M1a classification was based on the presence of the presumed malignant pericardial and pleural effusions. 

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