Lung cancer

Case contributed by Dr Ian Bickle

Presentation

Retired male with 38 year pack history of smoking. Cachexia. Mass on right chest wall.

Patient Data

Age: 65 years
Gender: Male
Modality: Photo

Painless right chest wall mass lateral to the nipple.

The skin is intact.

Modality: X-ray

Large right mid-zone mass.

No overt bone destruction.

Right upper lobe nodule.

Modality: CT

Large mass in the lateral segment of the right middle lobe extending through the chest wall into the soft tissues of the chest.  The mass is low attenuation suggesting necrosis/infarction.

Destruction of the 5th and 6th ribs.

Further lung nodules including a cavitating nodule in the right upper lobe.

Ultrasound guided biopsy was undertaken

Modality: Ultrasound

The right lung mass is clearly delineated on ultrasound including the infiltration through the chest wall (linear probe images).

Core biopsy through the centre of the mass shown.

Case Discussion

A rather striking chest x-ray for a rather common patholgy.

Couple of practical points:

  1. CT is not always needed for lung biopsy is one lesson from this case ( it would be so much more hassle than using ultrasound ).
  2. Choose the site for biopsy with insight - core the perceived viable tissue (maybe at the periphery of the mass) or core in two different parts of the mass.
  3. Alas, the latter was done, but 2 cores of infarcted tissue were acquired - immunohistochemical staining was sufficient to conclude a lung carcinoma.
PlayAdd to Share

Case Information

rID: 38150
Case created: 8th Jul 2015
Last edited: 30th Jan 2017
System: Chest
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.