Lung cancer - widened mediastinum (chest x-ray)

Case contributed by Philipp Widmayer

Presentation

Routine chest xray prior to a minor surgical procedure. Known history of tobacco consumption.

Patient Data

Age: 60 years
Gender: Male

Hilar space-occupying lesion with an elongated opacity in projection to the left upper zone. Lateral to the apex of the heart, an oval-shaped shadow measuring approximately 1.7 x 0.7 cm is visible The upper mediastinum is convexly widened on the right side.

Annotated image

Marked in red is the described elongated opacity. 

Image of a max. 5cm peripheral bronchial mass with two to 1.5 cm satellite foci and intrapulmonary, left hilar and extensive mediastinal lymph node metastases (aortopulmonary window, subcarinal and paracaval up to 2.5cm with single necrotic parts). Singular 1cm right hilar lymph node. 

Normal-size heart, massive calcification of all coronary arteries.

Approximately 5mm lateral pleural space mass in the left anterior upper lobe.

Bilateral enlarged adrenal glands (right >left).

5mm large cyst in the 4th liver segment. 2cm large accessory spleen, ventral to the spleen.

 

Nuclear medicine

Hypermetabolic focus in the mediastinum and upper lobe of the left lung.

Other hypermetabolic foci include right paratracheal as well as infracarinal and left supra- as well as infrahilar regions.

No hypermetabolic foci were seen in the bilateral enlarged adrenal glands.

Cytological findings

Right paratracheal lymph node biopsy sample: Tumor cells of an adenocarcinoma, well compatible with a primary lung carcinoma.

Case Discussion

Enlargement of the upper mediastinum with intrapulmonary mass are both strongly suggestive of malignancy on a chest x-ray. Routine radiographic examinations are important in screening for the presence of lung cancer and other lung pathologies.

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