Case 22
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.