Presentation
Presents with exacerbation of COPD. Ex-smoker
Patient Data
A large, lobulated mass is seen in the right upper lobe with evidence of mediastinal and right hilar invasion. The mass measures up to 8.5 x 5.7cm in maximum axial dimension and extends over a craniocaudal distance of approximately 7.6cm. At its superior margin, it demonstrates some coarse calcification. As the mass invades right sided of the mediastinum it encases the right upper lobe pulmonary artery and its proximal branches, extends around the posterior and right lateral lower trachea and encases the origin of the right main bronchus which is markedly narrowed and likely invaded. There is minor surrounding ground glass opacity in the posterior right lung apex and minimal right basal atelectasis. No pleural or pericardial effusion. An enlarged 15.3 x 11mm pretracheal lymph node is demonstrated. Previous sternotomy wires and evidence of cardiac surgery. Vascular calcification.
Within the liver, several low attenuation lesions are demonstrated. The largest measuring 19.5 mm in the inferior left lobe. Although non-specific, they have features suggestive of hepatic cysts. Some however are too small to characterize. The liver itself has been incompletely imaged. The adrenal glands have a normal appearance. No suspicious bony lesion.
Large right upper lobe mass with evidence of mediastinal, hilar and bronchial invasion described most likely represents primary lung carcinoma. Incompletely imaged liver with several low attenuation lesions, some of which have features to suggest cysts. Further evaluation with hepatic ultrasound is recommended.
The patient went on to have a bronchoscopy.
Pathology:
- TBNA right lung mass: Small cell carcinoma.
- Bronchial washings right: Atypical cells present, suspicious for malignancy.
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