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Adenocarcinoma of the Lung

Steel CJS - MedPix (2011)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Adenocarcinoma of the Lung

History: 60 year old woman presents with acute shortness of breath. She also endorses hoarseness, chest discomfort, cough, and increasing sputum production over the past 6 months. She denies any chest pain, hemoptysis, fever, chills, night sweats, weight loss. She endorses significant secondhand smoke exposure for the past six years. Chest x-ray performed one month ago did not reveal any abnormalities. She was diagnosed with a URI and treated with two courses of antibiotics at the time.

Findings: •CXR: New bandlike area of opacification in the left upper lobe, not seen on previous exam. •CT chest w/ contrast: Large aggregation of mediastinal adenopathy involving left and right paratracheal, subcarinal, prevascular, aortic window, and left hilar nodes. There is partial obstruction of the left main stem bronchus and at the carina, likely representing peribronchial invasion. There is a significant mass effect on the left pulmonary artery and left subclavian vein, with possible invasion. In the left upper lobe there is a 2 cm spiculated focus of consolidation. In the right hepatic lobe of the liver, near the dome, there is a 1.2 x 0.8 cm area of low attenuation. Within segment 2 of the liver a 2.2 x 3.5 cm hypoattenuating lesion demonstrates peripheral enhancement. A similar lesion is seen in segment 8 of the right lobe, measuring 1.2 x 2.4 cm. There is a low-attenuating pericardial effusion.

Ddx: •Primary Lung Cancer •Metastatic cancer to the lung •Pneumoconiosis •Sarcoidosis •Asbestosis •Pneumonia

Dxhow: Bronchoscopy with biopsy

Exam: Vital Signs: BP 140/89, HR 93, RR 22, T 99.5 Gen: Alert and oriented female in no acute distress. HEENT: Normal with no lymphadenopathy noted Lungs: Clear to auscultation bilaterally. No wheezing, ronchi, rales CV: Normal S1, S2. No murmurs, rubs, gallops. Abd: Nontender, nondistended. Normal active bowel sounds. Neuro: 5/5 strength, no sensory deficits Abnormal Labs -WBC 13.9 (90.8% neut), Platelets 497 -Aspartate Aminotransferase (AST) 36 -ESR 39

No MeSH data available.


There is poor visualization of the mediastinum, due to overlapping arm shadows.
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MPX1871_synpic56298: There is poor visualization of the mediastinum, due to overlapping arm shadows.


Adenocarcinoma of the Lung

Steel CJS - MedPix (2011)

There is poor visualization of the mediastinum, due to overlapping arm shadows.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1871&req=5

MPX1871_synpic56298: There is poor visualization of the mediastinum, due to overlapping arm shadows.

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Adenocarcinoma of the Lung

History: 60 year old woman presents with acute shortness of breath. She also endorses hoarseness, chest discomfort, cough, and increasing sputum production over the past 6 months. She denies any chest pain, hemoptysis, fever, chills, night sweats, weight loss. She endorses significant secondhand smoke exposure for the past six years. Chest x-ray performed one month ago did not reveal any abnormalities. She was diagnosed with a URI and treated with two courses of antibiotics at the time.

Findings: •CXR: New bandlike area of opacification in the left upper lobe, not seen on previous exam. •CT chest w/ contrast: Large aggregation of mediastinal adenopathy involving left and right paratracheal, subcarinal, prevascular, aortic window, and left hilar nodes. There is partial obstruction of the left main stem bronchus and at the carina, likely representing peribronchial invasion. There is a significant mass effect on the left pulmonary artery and left subclavian vein, with possible invasion. In the left upper lobe there is a 2 cm spiculated focus of consolidation. In the right hepatic lobe of the liver, near the dome, there is a 1.2 x 0.8 cm area of low attenuation. Within segment 2 of the liver a 2.2 x 3.5 cm hypoattenuating lesion demonstrates peripheral enhancement. A similar lesion is seen in segment 8 of the right lobe, measuring 1.2 x 2.4 cm. There is a low-attenuating pericardial effusion.

Ddx: •Primary Lung Cancer •Metastatic cancer to the lung •Pneumoconiosis •Sarcoidosis •Asbestosis •Pneumonia

Dxhow: Bronchoscopy with biopsy

Exam: Vital Signs: BP 140/89, HR 93, RR 22, T 99.5 Gen: Alert and oriented female in no acute distress. HEENT: Normal with no lymphadenopathy noted Lungs: Clear to auscultation bilaterally. No wheezing, ronchi, rales CV: Normal S1, S2. No murmurs, rubs, gallops. Abd: Nontender, nondistended. Normal active bowel sounds. Neuro: 5/5 strength, no sensory deficits Abnormal Labs -WBC 13.9 (90.8% neut), Platelets 497 -Aspartate Aminotransferase (AST) 36 -ESR 39

No MeSH data available.