Dept of General MedicineStanley Medical College

Image of the week…

Prof.Dr.Magesh Kumar’UnitDr.Bala murugan

62yr old male chronic smoker has admitted with c/o

dysphagia for solids –2 monthsDifficulty in breathing—1monthEngorged veins over the chest—2weeksCongestion over the face and eyelids—5days X-ray was taken…

• X-ray chest PA view, slight malrotation present

• Dense opacity in right upper lobe• Pulling of minor fissure upwards• Lobulated ? mass lesion in right perihilar

region• Right cardiac silhoutte sign present• Obliteration right CPA• scoliosis in the lower dorsal spine

CT Chest

• Right upper lobe homogenous dense opacity is seen

• Pleural effusion is seen.• Erosion of ribs present.• Lobulated mediastinal lymph nodes.

X-ray manifestations of Ca Lung

• Hilar enlargement:may be due to primary tumor or lymph

node metastasisbest demonstrated by CT / MRI

Airway Obstuction:collapse of lung distal to tumormay lead to consolidationbut air bronchograms usually absentexcept in Alveolar cell Ca.

• Peripheral mass lesions:Points to favor benign lesionssmall sizewell defined lesionsatellite opacitiesdiffuse or central calcificationvery long doubling time

But biopsy is needed to confirm.

• CavitationThick walled irregular nodular inner margin with air fluid level

Primary tumor in the left hilum.Lytic lesion the Right rib

A large round soft tissue mass in righr apex with blunting of costophernic angle

Same person showing a x-ray taken 6 months after the first one. Tumor has enlarged caviated and bulging in aorto-pulmonary window indicating lymph node enlargement

Enlargement of the left hilum due to lymph adenopathyPrimary tumor not visible

Soft tissue nodule in left mid zone with hilar prominence

Collapse of entire lung