Presentation
Cough, shortness of breath and subjective fevers.
Patient Data
Consolidation in the medial segment of the right middle lobe obscures the right heart border.
No bony abnormalities, pleural effusion or pneumothorax.
Large right paratracheal mass.
Almost complete "white out" of the right lung with little aerated lung visible in the right apex.
Right-sided volume reduction and a noticeable rightward midline shift indicating collapse of the right lung.
Occluded right main bronchus.
Large, confluent right paratracheal nodes narrowing the distal trachea and occluding the right main bronchus.
The right tracheobronchial tree is full of mucus (drowned lung), and the right lung is atelectatic.
Right adrenal metastasis.
Case Discussion
This case illustrates a patient with lung atelectasis secondary to mediastinal lymphadenopathy.
This patient was initially diagnosed as a right middle lobe pneumonia and treated with antibiotics. With no improvement of symptoms, he subsequently re-presented to the emergency department and had follow-up chest radiograph and CT. Findings confirmed a malignant process.
Bronchoscopy and Histopathology Report:
Bronchoscopy showed a highly vascular mass invading the distal trachea. There was near complete occlusion of right main bronchial orifice. Biopsies were taken and sent to histopathology.
Immunohistochemistry and gene typing showed malignant epithelioid cells positive for CK7 and GATA3 only. EGFR and KRAS mutations were not detected.
Diagnosis: Non-small cell carcinoma.
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