Presentation
Cough and hoarse voice. Significant smoking history and alcoholism. Weight loss.
Patient Data
Background COPD. Large soft tissue density mass in the superior left hilum. No evidence of consolidation or pleural effusion. Bilateral apical pleural thickening. Proximal airways are patent. The trachea is deviated to the right at the level of the aortic arch and left hilum.
Mottled appearance of the posterior left third rib of uncertain origin.
The scan is of good diagnostic quality. No pulmonary arterial filling defect identified. No signs of right ventricular strain. The heart is normal.
Large left hilar mass located below the aortic arch invading the mediastinum and encasing the left pulmonary artery. The mass causes mild extrinsic compression on left pulmonary artery with near complete compression of the left anterosuperior segmental artery. The carina is mildly displaced to the right. No other perihilar or mediastinal lymphadenopathy.
Diffuse mild centrilobular emphysema with multiple apical and anterior bullae. Ground glass attenuation adjacent to the left hilum. There are a few small pulmonary nodules in the apicoposterior segment of the left upper lobe. This lobe demonstrates reduced perfusion confirming severe extrinsic compression of the pulmonary arteries by the left hilar mass. No bronchial stenosis. No pleural effusion.
Enlarged left supraclavicular lymph node.
Innumerable irregular liver hypodensities of various sizes. Porta hepatis and retrocaval lymphadenopathy. The adrenal glands, kidneys and spleen are normal.
No concerning osseous lesions.
Impression
No PE identified to the level of the subsegmental arteries.
Large left hilar and mediastinal mass causing mass effect on adjacent structures; multiple liver hypodensities; retrocaval and porta hepatis lymphadenopathy. Features consistent with a metastatic malignancy. Given the appearance of the mass and background emphysematous disease in a lifelong smoker, the provisional diagnosis is of bronchogenic carcinoma with hepatic and pulmonary metastatic disease.
Case Discussion
A left supraclavicular US-guided lymph node FNA was performed and demonstrated metastatic small cell carcinoma.
The patient was staged as extensive stage small cell lung cancer (with diffuse bony and liver metastases) and offered chemotherapy and immunotherapy but progressed rapidly and passed away 3 months after diagnosis.
Unable to process the form. Check for errors and try again.