Metastatic adenocarcinoma of the lung

Case contributed by Ian Bickle
Diagnosis certain

Presentation

Right upper quadrant pain. Left sided painless neck mass.

Patient Data

Age: 70 years
Gender: Male

10 cm spiculated mass left upper lobe. The left upper lobe mass is contiguous with the large soft tissue density lesions in the mediastinum in the aortopulmonary window, prevascular and left tracheobronchial region with bulk dimensions of 8.5 x 5 cm. 

1.2 cm nodule is seen in the left upper lobe.

Precarinal lymphadenopathy, right lower paratracheal node. Right upper anterior mediastinal enlarged lymph nodes, measuring 2.8 cm.

2.3 cm left supraclavicular node.

Emphysematous change in both lungs.

Abdomen

ct

Three hypodense lesions are seen in the liver, 1.9 cm in segment III, and two 2cm lesions in segment VII.

6.2 cm left adrenal mass.

4.4 cm lobulated peritoneal mass indenting the anterior border of segment IV of the liver and several other smaller peritoneal nodules seen for example medial to the hepatic flexures and in posterior right subdiaphragmatic region.

1.2 cm nodule is seen in left anterior pararenal space. 2.1 cm nodule seen inferomedial to the spleen is indeterminate.

Enlarged lymph nodes are seen in the left para-aortic and right common iliac regions, measuring up to 1.8 cm.

3.0 x 2.2 cm enhancing nodule is seen in the posterior wall of the urinary bladder, immediately medial to the right vesicoureteric junction.

No destructive bony lesion.

6 cm fusiform infrarenal aortic aneurysm with mural thrombus.

Case Discussion

An example of advanced non-small cell lung cancer at presentation.

Radiological stage: T4, N3, M1c

Ultrasound-guided biopsy of a left supraclavicular lymph node was undertaken.

Result:   Metastatic adenocarcinoma of the lung.

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