Lung cancer

Case contributed by Dr Ian Bickle


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

Patient Data

Age: 65 years
Gender: Male

Painless right chest wall mass lateral to the nipple.

The skin is intact.


Large right mid-zone mass.

No overt bone destruction.

Right upper lobe nodule.


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

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

Core biopsy through the center 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.
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Case information

rID: 38150
Published: 14th Jul 2015
Last edited: 14th Aug 2019
System: Chest
Inclusion in quiz mode: Included