Lung cancer with lymphadenopathy - absent clavicular companion shadow
Presentation
Weight loss and cough.
Patient Data
Absent right clavicular companion shadow and increased opacity.
Small cavitating lesion in the right upper lobe and small subpleural solid satellite lesion.
The lymph nodes and small cavitating and solid right upper lobe lung lesions are FDG-avid.
Case Discussion
This a great example of an important CXR sign. The large supraclavicular lymph node mass displaces the skin and subcutaneous tissues over the right clavicle, obliterating the gas/skin interface. This parallel companion shadow is seen clearly on the left side.
US-guided supraclavicular lymph node biospy report extract:
" Consistent with metastatic adenocarcinoma of lung primary.
Moderate to poorly differentiated carcinoma with small nests and marked clear cell changes.
Immunohistochemical studies:
TTF1 +
CK7 +
Napsin A +
CK20 -
CDX2 -
GATA3 -
SOX10 -."
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