Presentation
Shortness of breath.
Patient Data
Increasing size of the right upper lobe cyst and irregular soft tissue thickening of the cyst wall compared to pCXR obtained one year ago.
Increasing size of the right upper lobe cyst and irregular soft tissue thickening of the cyst wall compared to CT obtained one year ago. There is soft tissue invasion of the lateral chest wall with destruction of the right lateral fourth and fifth ribs. The left upper lobe cyst is unchanged.
The right upper lobe cyst is visible, otherwise normal pCXR.
The right upper lobe cyst has increased in size compared to CT obtained 3 years ago and the wall has become thicker. The wall thickening is non-uniform and septations have developed in the cyst. The left upper lobe cyst is unchanged.
Normal.
No FDG uptake within cystic right upper lobe lesion. Evaluation is limited due to lack of significant soft tissue component.
Increasing size right upper lobe cyst compared to 2 years prior which is now slightly irregular with a thicker wall. Essentially unchanged left upper lobe cyst.
Small, thin-walled right upper lobe cyst. Larger thin-walled left upper lobe cyst. Mild emphysema. Minimal irregular soft tissue density right upper lobe, may represent scarring.
Pathology obtained after the CXR at year 0 confirms suspected lung cancer.
Case Discussion
Lung cancers most commonly present as nodules or masses: thin walled cystic lung cancers such as this one are rare. CT scans obtained at over the course of 6 years shows a right upper lobe cyst slowly increasing in size, becoming irregular, developing septations and irregular peripheral soft tissue, concerning for cancer. Eventaually, the cancer invaded the right chest wall. The benign (presumably) left upper lobe cyst was stable, with a thin, nearly imperceptible wall.
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