Welcome to 2019! I will start the year with preoperative chest radiographs for meningioma in a 78-year-old woman.
More images will be shown on Wednesday.
What do you see?
Presenting CT images of the chest. Do they help?
Click here to see the solution
Findings: PA radiograph shows a bilobed lesion in the LLL (A, arrow) with ill-defined margins, which makes it intrapulmonary. It is rounded in the lateral view, with ill-defined inferior border (B, arrow).
Enhanced axial CT shows a pulmonary mass with little enhancement (C, arrow). Coronal and sagittal views show distal pulmonary impactions (D-E, arrows), suggesting an intrabronchial location.
Bronchoscopy confirmed an intrabronchial mass in the L10 segmental bronchus. Biopsy returned as atypical carcinoid.
Final diagnosis: atypical carcinoid with distal bronchial impaction
Congratulations to Ner, who made a good interpretation of the plain film and CT. And saw a finding that I overlooked: increased posterior lucency in the lateral view. I reviewed the original CT and the lucency was not evident, although an expiratory CT was not done.
Teaching point: this case complements nicely my recent webinar on endobronchial lesions. Remember that bronchial mucous impaction is an important sign to suspect malignant endobronchial tumors.