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Non heamoptytic massive Rasmussen's pulmonary artery aneurysm caused by aggressive cavitating squamous cell carcinoma metastasis.

Chiruganti MV, Dattatreya PS, Shinkar PG, Sharma K, Prabhakar Rao VV - Indian J Nucl Med (2015 Apr-Jun)

Bottom Line: The authors report an extremely rare occurrence of a massive aneurysm of a major pulmonary artery branch vessel caused by adjacent necrotizing aggressive squamous cell carcinoma metastatic mediastinal nodes.Despite the huge size, there was no hemoptysis due to the walling off effect by the necrotic nodes.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Oncology, Omega Hospitals, Banjara Hills, Hyderabad, Telangana, India.

ABSTRACT
The authors report an extremely rare occurrence of a massive aneurysm of a major pulmonary artery branch vessel caused by adjacent necrotizing aggressive squamous cell carcinoma metastatic mediastinal nodes. Despite the huge size, there was no hemoptysis due to the walling off effect by the necrotic nodes.

No MeSH data available.


Related in: MedlinePlus

Axial positron emission tomography/computed tomography images of chest showing multiple metabolically active enlarged mediastinal lymphadenopathy with conglomeration and central necrosis (arrows) and a contrast filled cavitary area amidst the necrotic lymph nodal mass devoid of any fluoro deoxy glucose avidity (dotted arrow)
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Figure 3: Axial positron emission tomography/computed tomography images of chest showing multiple metabolically active enlarged mediastinal lymphadenopathy with conglomeration and central necrosis (arrows) and a contrast filled cavitary area amidst the necrotic lymph nodal mass devoid of any fluoro deoxy glucose avidity (dotted arrow)

Mentions: A 65-year-old male of primary squamous cell carcinoma left buccal mucosa treated by left composite resection, and modified radical neck dissection 8 months back. Postsurgery local radiation with 25 fractions of 2 Grey (Gy) each completed just 4 months before, presented with generalized weakness and pain right hip region. There was no history of fall, fever, loss of weight or bleeding from any site. Clinical examination revealed no evidence of disease at the local site and no palpable masses anywhere in the body and there was no neurological deficit. Hematological, bio chemical and metabolic parameters were within normal limits, except mild hypo chromic normocytic anemia. Initial imaging with magnetic resonance imaging of lumbo sacral spine revealed T1 hypointense and T2 hyperintense signal intensities in right sacral ala and iliac bone lesions suggestive of metastatic lesions. Patient was subjected to fluorine 18-fluoro deoxy glucose positron emission tomography/computerized tomography (F18-FDG) for restaging and further evaluation. The primary site of left buccal region showed postoperative status with no morphological or metabolic abnormality. There was a metabolically active enhancing nodular mass lesion on the dorsum of the tongue measuring 30 × 19 mm with a standardized uptake value maximum (SUV max) of 5.77 [Figure 1a], similar nodular deposit in the cervical nuchal muscle measuring 22 × 21 mm with an SUV max of 4.82 [Figure 1b]. There were multiple bilateral metabolically active necrotic, nodular, sub pleural and parenchymal pulmonary metastasis with associated mild degree pneumothorax [Figure 2]. Mediastinum showed multiple metabolically active enlarged lymphadenopathy encompassing bilateral hilar, sub aortic, and para aortic lymphadenopathy which also showed conglomeration and central necrosis. Interestingly there was a large contrast filled cavitary area measuring 66.6 × 54.8 × 72.6 mm seen amidst the necrotic lymph nodal mass, devoid of any FDG avidity [Figure 3]. On close scrutiny the radiographic contrast collection was traceable up to one of the adjoining first order branch of left pulmonary artery [Figure 4]. There were multiple metabolically active mixed lytic sclerotic disseminated skeletal metastasis as well [Figure 5]. Due to his poor physical condition and the extensive disease load. Small asymptomatic unilateral pneumothorax requiring no intervention and the large extravasated contrast being restricted within the confines of the cavitating nodal metastasis explaining the stark absence of hemoptysis, patient was managed conservatively without any active intervention shifting from a curative to palliative intent.


Non heamoptytic massive Rasmussen's pulmonary artery aneurysm caused by aggressive cavitating squamous cell carcinoma metastasis.

Chiruganti MV, Dattatreya PS, Shinkar PG, Sharma K, Prabhakar Rao VV - Indian J Nucl Med (2015 Apr-Jun)

Axial positron emission tomography/computed tomography images of chest showing multiple metabolically active enlarged mediastinal lymphadenopathy with conglomeration and central necrosis (arrows) and a contrast filled cavitary area amidst the necrotic lymph nodal mass devoid of any fluoro deoxy glucose avidity (dotted arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4379684&req=5

Figure 3: Axial positron emission tomography/computed tomography images of chest showing multiple metabolically active enlarged mediastinal lymphadenopathy with conglomeration and central necrosis (arrows) and a contrast filled cavitary area amidst the necrotic lymph nodal mass devoid of any fluoro deoxy glucose avidity (dotted arrow)
Mentions: A 65-year-old male of primary squamous cell carcinoma left buccal mucosa treated by left composite resection, and modified radical neck dissection 8 months back. Postsurgery local radiation with 25 fractions of 2 Grey (Gy) each completed just 4 months before, presented with generalized weakness and pain right hip region. There was no history of fall, fever, loss of weight or bleeding from any site. Clinical examination revealed no evidence of disease at the local site and no palpable masses anywhere in the body and there was no neurological deficit. Hematological, bio chemical and metabolic parameters were within normal limits, except mild hypo chromic normocytic anemia. Initial imaging with magnetic resonance imaging of lumbo sacral spine revealed T1 hypointense and T2 hyperintense signal intensities in right sacral ala and iliac bone lesions suggestive of metastatic lesions. Patient was subjected to fluorine 18-fluoro deoxy glucose positron emission tomography/computerized tomography (F18-FDG) for restaging and further evaluation. The primary site of left buccal region showed postoperative status with no morphological or metabolic abnormality. There was a metabolically active enhancing nodular mass lesion on the dorsum of the tongue measuring 30 × 19 mm with a standardized uptake value maximum (SUV max) of 5.77 [Figure 1a], similar nodular deposit in the cervical nuchal muscle measuring 22 × 21 mm with an SUV max of 4.82 [Figure 1b]. There were multiple bilateral metabolically active necrotic, nodular, sub pleural and parenchymal pulmonary metastasis with associated mild degree pneumothorax [Figure 2]. Mediastinum showed multiple metabolically active enlarged lymphadenopathy encompassing bilateral hilar, sub aortic, and para aortic lymphadenopathy which also showed conglomeration and central necrosis. Interestingly there was a large contrast filled cavitary area measuring 66.6 × 54.8 × 72.6 mm seen amidst the necrotic lymph nodal mass, devoid of any FDG avidity [Figure 3]. On close scrutiny the radiographic contrast collection was traceable up to one of the adjoining first order branch of left pulmonary artery [Figure 4]. There were multiple metabolically active mixed lytic sclerotic disseminated skeletal metastasis as well [Figure 5]. Due to his poor physical condition and the extensive disease load. Small asymptomatic unilateral pneumothorax requiring no intervention and the large extravasated contrast being restricted within the confines of the cavitating nodal metastasis explaining the stark absence of hemoptysis, patient was managed conservatively without any active intervention shifting from a curative to palliative intent.

Bottom Line: The authors report an extremely rare occurrence of a massive aneurysm of a major pulmonary artery branch vessel caused by adjacent necrotizing aggressive squamous cell carcinoma metastatic mediastinal nodes.Despite the huge size, there was no hemoptysis due to the walling off effect by the necrotic nodes.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Oncology, Omega Hospitals, Banjara Hills, Hyderabad, Telangana, India.

ABSTRACT
The authors report an extremely rare occurrence of a massive aneurysm of a major pulmonary artery branch vessel caused by adjacent necrotizing aggressive squamous cell carcinoma metastatic mediastinal nodes. Despite the huge size, there was no hemoptysis due to the walling off effect by the necrotic nodes.

No MeSH data available.


Related in: MedlinePlus