Presentation
Admitted via the emergency department with dysuria and suspected urinary tract infection. A routine chest x-ray was acquired.
Patient Data
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The most striking finding is a round lesion in the left upper lobe measuring approx. 2 x 2 x 2 cm in size.
Besides degenerative changes of the thoracic spine no other pathologies.
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Main findings:
- a highly suspicious mass lesion in the apical upper lobe segment on the left side with a maximum diameter of 2 cm
- suspected satellite lesion in the apicoposterior segment of the upper lobe ipsilaterally. At least two suspicious mediastinal lymph nodes
Suspected bronchus carcinoma results in the following TNM classification: T3, N2, Mx.
Other findings:
- mild perinephric fat stranding on the right side and to a lesser degree at the left. No ureteral obstruction
- enlarged and inhomogeneously contrasted right ovary
- multiple variable sized cystic hepatic focal lesions
- prominent abdominal aorta atherosclerotic changes
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In retrospect, a circular lesion in the left upper field zone is barely distinguishable.
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Intense hypermetabolic focus in the left apical upper lobe.
Two hypermetabolic foci in the left upper mediastinum.
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Histopathology showed cells of non-small cell lung cancer.
Case Discussion
In retrospect, the newly diagnosed highly suspicious lesion was already distinguishable in the chest x-ray 1.5 years earlier.
Unfortunately, the round lesion in the left upper lobe was overlooked or misinterpreted as of vascular origin. Discovery in this early stage would have resulted in a better patient outcome.