Malignancy – ChestDB.com

Case 33

Malignancy / Age 31-60, Breast Implant, Breast Reconstruction, Metastasis

This radiograph demonstrates a lobulated mass in the left perihilar region. Also of note is the presence of a unilateral implant in the left breast, suggesting a history of mastectomy and breast reconstruction. Together these findings are highly suggestive of pulmonary metastatic disease from breast cancer. However, tissue diagnosis would be required for confirmation as a primary lung malignancy and metastatic disease from a different, unknown primary are also possible.

The exam is otherwise unremarkable.

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Case 22

Malignancy / Age 31-60, Kerley B Lines, Lymphadenopathy, Lymphangitic Carcinomatosis, Lymphangitic Spread of Malignancy, Metastatic Disease, Paratracheal Stripe Thickening

This patient presented with a mass at the base of his right neck which is evident on this radiograph. There is a unilateral increase in interstitial markings seen only in the right lung. Kerley B lines are also seen in the right lung base, but there is little other evidence to suggest pulmonary edema or fluid overload. Other pertinent findings include thickening of the right paratracheal stripe and an asymmetrically prominent right hilum.

This constellation of findings is concerning for malignancy causing venous and lymphatic obstruction as well as lymphangitic spread of malignancy and should prompt further evaluation with CT. In this case, the neck mass, thickening of the paratracheal stripe, and the prominent right hilum all corresponded to lymphadenopathy on CT and there was nodular interlobular septal thickening, confirming lymphangitic carcinomatosis. Further investigation in the abdomen revealed a large renal mass as the likely primary malignancy.

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Case 9

Malignancy / Age >61, Cervicothoracic Sign, Pancoast Tumor, Portable, Rotation

This radiograph demonstrates a paramedian mass in the right lung apex, colloquially referred to as a Pancoast tumor. The lateral margin of the mass is visible above the clavicle, which localizes the mass to the posterior mediastinum (negative cervicothoracic sign). The patient is slightly rotated to the left. Multiple chronic bilateral rib fractures are present. A nipple ring projects over the left chest wall.

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