Lung cancer with left atrial thrombus

Case contributed by Dr Craig Hacking

Presentation

Asymptomatic mass on CXR

Patient Data

Age: 60-65 years
Gender: Female

Large left hilar mass lesion is seen measuring 5cm in size. The mass demonstrates some internal enhancement within vessels also seen traversing the mass with obliteration. No cavitation or calcification. There is no evidence of adjacent bronchial invasion/obstruction. Peripherally within the left upper lobe there are further smaller nodular foci with surrounding groundglass change. Hazy groundglass opacification is also demonstrated within the lingular segment of the left upper lobe, abutting the oblique fissure. To a lesser degree, groundglass opacification is also seen within the left lower lobe predominantly involving the superior and anteromedial segments. Mild left basal atelectasis.

The right lung is clear. No pleural effusion.

Filling defect in the auricle of the left atrium represents thrombus.

Multiple enlarged mediastinal lymph nodes the largest of which is right lower paratracheal measuring up to 3 cm in maximal size ( likely confluent nodal mass ). Small punctate calcific focus is noted within. There is also an enlarged right hilar lymph node measuring up to 11 mm in short axis.

No destructive osseous lesion.T7 and T9 vertebral body haemangiomas.

Limited views of the upper abdominal viscera appear within normal limits.

Conclusion

  • Large left hilar mass lesion measuring up to 5.5 cm in size. There are multiple further nodular parenchymal foci surrounding the mass as well as patchy areas of groundglass opacification within the left upper and lower lobes. There is also mediastinal and hilar lymphadenopathy.
  • Appearances are in keeping with primary bronchogenic malignancy. A transbronchial biopsy is suggested for diagnostic purposes.
  • Filling defect in the auricle of the left atrium represents thrombus. It is not contiguous with a nodal mass or the primary lesion, suggesting bland thrombus rather than tumour invasion.

Case Discussion

Bx proven lung cancer.

The patient subsequently developed splenic and cerebral infarcts despite anticoagulation.

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Case information

rID: 40148
Case created: 9th Oct 2015
Last edited: 21st Aug 2017
Systems: Chest, Cardiac
Inclusion in quiz mode: Included

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