Presentation
Hemoptysis.
Patient Data
Large masses project posterior to and over the left hilum, which is best seen on the lateral projection. Leftward mediastinal shift and increased medial left lower zone opacity. Mass adjacent to the aortic knuckle with a convex outer border but not obliterating to the AP window.
Left inferior hilar mass occluding the left posterior basal segmental bronchus and left main bronchus narrowing. The mass appears contiguous with subcarinal lymph nodes. Downstream segmental atelectasis.
Mediastinal lymphadenopathy, largest node is prevascular.
No pleural or pericardial effusion. No pulmonary nodule. No adrenal or liver mass. No destructive bone lesion.
Centrilobular emphysema. No pulmonary embolus. Small hiatus hernia.
Case Discussion
This locally invasive left inferior hilar mass is almost certainly a primary lung cancer with downstream segmental atelectasis and locoregional nodal disease. The findings on the frontal chest x-ray are mainly about secondary signs of volume loss and a mediastinal mass near the aortic knuckle, although the hilar masses are easily seen on the lateral projection.
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