Malignancy

Case 50

Malignancy / , , ,

This radiograph demonstrates numerous round nodules and masses in a young patient consistent with metastatic disease. These are sometimes referred to as “cannonball” metastases because of their large size and round shape. They are classically associated with renal cell carcinoma and choriocarcinoma, though other primary tumor metastases can also have a cannonball appearance. In young male patients in particular, the search for a primary tumor should include a scrotal ultrasound. In this patient, testicular cancer was identified on physical exam and imaging.

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Case 44

Malignancy / , , , , ,

This radiograph demonstrates left upper lobe collapse. This is one of the more challenging lobar collapse patterns to recognize on AP or PA radiographs as the left upper lobe collapses anteriorly and superiorly and ends up superimposed over the inflated left lower lobe. Other than the increased opacity over the left hemithorax, other notable features present on this radiograph are a left juxtaphrenic peak sign and silhouetting of the left heart border and hilum by the collapsed left upper lobe.

When this finding is identified, the cause of the collapse should be further investigated with CT. This case was post-obstructive collapse secondary to a central obstructing mass. The mass is not well visualized on this radiograph.

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Case 42

ICU/Surgery, Lines/Tubes/Devices, Malignancy / , , , , ,

This patient underwent bilateral mastectomies for breast cancer. Surgical clips from an axillary lymph node dissection are seen on the right side. The bilateral rounded metallic devices are tissue expanders. They are attached to a radiolucent inflatable bladder that can be progressively filled with saline to stretch the overlying soft tissues, creating redundant tissue that can later be used for reconstruction. The underlying lungs are clear.

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Case 38

Malignancy / , , , , ,

This radiograph demonstrates a well circumscribed mass in the left upper chest. There is no silhouetting of the posterior arch and proximal descending aorta, placing the mass outside of the posterior mediastinum. The finding is subtle, but the anterior left 1st rib should project over the mass but is not visualized. This finding localizes the mass to the anterior chest wall with 1st rib involvement. This patient has a diagnosis of multiple myeloma, which favors plasmacytoma as the diagnosis.

Also partly visualized is a left proximal humerus repair using fixation hardware and cement osteoplasty, necessitated by prior pathologic fracture in the setting of a myelomatous lesion. The exam is otherwise normal.

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Case 33

Malignancy / , , ,

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 / , , , , ,

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 vascular 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 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. Further investigation in the abdomen revealed a large renal mass as the likely primary malignancy.

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Case 9

Malignancy / , , , ,

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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