X-ray
Frontal
What is the next study of choice?
CT chest with contrast is the next study of choice to assess the large mass.
Heart is normal size.
A 6.5 to 7 cm mass is demonstrated overlying the left hilum, separate from the aortic arch and proximal descending thoracic aorta. Additional soft tissue density extending beneath the left mainstem bronchus consistent with subcarinal adenopathy.
No peripheral consolidation, pleural fluid or congestive failure demonstrated. No additional pulmonary mass is appreciated on screening AP portable radiograph.
Multiple healed left rib fractures noted. Moderate degenerative changes involve both shoulders.
Upper bowel gas pattern within normal limits.
OPINION:
Large left perihilar pulmonary mass with subcarinal adenopathy. Given past smoking history, primary lung cancer considered most likely.