Today’s radiographs belong to a 59-year-old man with two week’s history of chest pain and moderate dyspnea.
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Findings: PA radiograph shows a diffuse opacity of left lung (A, asterisk) which obscures the heart border. A luftsichel sign is visible (A, circle). The left hilum is augmented, and the left main bronchus has a horizontal path (A, red arrow). The left hemidiaphragm is elevated and a juxtaphrenic peak sign is visible (A, yellow arrow).
The lateral view shows a horizontal retro-sternal band (B, arrows) and a typical donut sign (B, circle).
Donut sign is more obvious when comparing with a normal previous chest film
This case is a compendium of typical signs of LUL collapse. As you all know, the most common cause is bronchogenic carcinoma, which in this case is confirmed by detecting enlarged mediastinal lymph nodes (donut sign).
Enhanced CT demonstrates the LUL collapse (E-F, asterisks), a mass occluding the bronchus (E-F, red arrows) and subcarinal adenopathy (E-F, arrows).
Final diagnosis: carcinoma of LUL bronchus with lobar collapse and mediastinal metastases.