Cáceres’ Corner Case 196 – SOLUTIONS


Dear Friends,

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?

Click here to see the images showed on Monday

Dear Friends,

Presenting CT images of the chest. Do they help?

Click here to see more images

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.