Lung cancer with lymphangitis carcinomatosis and situs inversus

Case contributed by Dr Alexandra Stanislavsky


New deterioration and dyspnoea in a patient known to the respiratory unit

Patient Data

Age: 70 years
Gender: Female

There are many findings to observe in this case.

1. Of most immediate importance is the large left paramediastinal mass.  Associated thickened reticular markings in the left midzone suggest associated lymphangitis carcinomatosis. Note the surgical clip over the left hemithorax; there has been prior surgery and this is either a recurrent or metachronous malignancy.  The lungs are hyperexpanded, indicating COPD as the background risk factor.

2. The patient has had prior breast cancer.  Bilateral breast implants are present, of which the right is calcified, and there is a surgical clip in the right axilla, which points to a prior axillary dissection.

3. There is situs inversus.  Note the dextrocardia, right sided aortic arch and the gastric bubble located below the right hemidiaphragm.  

If not appreciated, the latter finding might confuse localization of the lung mass. The aortic border is well visualized on the left. It is important to realize that this represents the ascending aorta located anteriorly, and not the descending aorta. The mass is therefore likely posterior/prevertebral - and this is confirmed on the subsequent CT.

CT helps to clarify the multiple findings seen on chest x-ray

Case Discussion

This is an "observational" case.  No complex pathology, but much to see.  

The distorted anatomy due to dextrocardia and a right sided aortic arch, as well as the "distractor factor" of a calcified breast implant and evidence of prior breast cancer, might draw one's attention away from the main finding - the large left paramediastinal lung cancer with lymphangitis carcinomatosis.

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Case information

rID: 37084
Published: 25th May 2015
Last edited: 14th Aug 2019
System: Chest
Inclusion in quiz mode: Included

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