Thickened right paratracheal stripe - small cell lung carcinoma

Case contributed by Matthew Tse
Diagnosis certain


Chest pain. Previous right breast lumpectomy and nodal sampling 10 years prior.

Patient Data

Age: 70 years
Gender: Female

Chest X-ray (current)


Apparent thickening of the right paratracheal stripe inferiorly.
No gross collapse or consolidation. No pleural effusion demonstrated.
Right breast and right axillary surgical clips.
Unremarkable bony thorax.

CXR from 2 years prior


Previous right breast surgery. Lungs and pleural spaces clear. 

Enlarged right hilar and paratracheal nodes

Mild fibrotic lung changes. Small pulmonary nodules suspicious for metastases.

Normal appearances of upper abdominal solid viscera.

Unremarkable partially imaged unprepared bowel.

No concerning bony abnormality.

Right breast and axillary nodal surgical clips.

Case Discussion

Given the evidence of previous breast surgery, clinical concern is of nodal recurrence of breast cancer. Primary lung cancer remains a possibility if primary lesion is hidden within the right hilar nodal enlargement.

The patient subsequently underwent bronchoscopy and endoscopic ultrasound guided nodal sampling, which demonstrated malignant cells consistent with metastatic small cell carcinoma.

This case highlights the importance of review areas, in particular the right paratracheal stripe, and evidence that may point to possibility of nodal disease, in this case the evidence of previous breast surgery, though in this case the lymphadenopathy was due to new metastatic lung malignancy rather than recurrence of breast malignancy.

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