Presentation
Presents with cough, causing weakness and collapse.
Patient Data
There is an alveolar pattern in the cranial subsegment of the left cranial lung lobe with visible air bronchograms and a lobar sign. Patchy, ill-defined nodules are present in the caudal subsegment of the left cranial lung lobe, coalescing to an alveolar pattern ventrally. The remainder of the pulmonary parenchyma is normal. No abnormalities are noted in the cardiovascular structures, mediastinum, or pleural space. In the portion of the abdomen included, the stomach is moderately distended with gas.
Impression: The left cranial lung lobe is most likely affected by primary pulmonary neoplasia. Infectious inflammatory disease is less likely.
There is a large, soft tissue attenuating, mildly heterogeneously contrast enhancing mass present, filling the cranial subsegment of the left cranial lung lobe. There is soft tissue attenuation and nodules throughout the ventral aspect of the caudal subsegment of the left cranial lung lobe and the ventral aspect of the left caudal lobe, with concurrent volume loss. There is a soft tissue nodule in the right caudal lung lobe.There are bullae in the dorsal aspect of the right cranial lung lobe, in the dorsal aspect of the right caudal lobe, and in the dorsal aspect of the left caudal lung lobe. There is a mildly enlarged cranial mediastinal lymph node adjacent to the left cranial lung lobe mass, measuring 6mm in thickness. The intrathoracic aorta is moderately enlarged.
The left cranial lung lobe is consolidated, firm, and tan in color. This corresponds to the area of abnormality seen on the CT images. An additional nodule is visible on the surface of the left caudal lung lobe. The necropsy was performed 6 months after the CT scan.
Case Discussion
On necropsy, the mass was diagnosed as a primary apillary adenocarcinoma affecting the left cranial lung lobe.
The cranioventral location of the mass could be mistaken for aspiration pneumonia; however, the nodular change is more indicative of neoplasia. Adenocarcinoma can spread diffusely through a lung lobe and spread to neighboring lobes.
The mass is not visualized well on the lateral projections, likely due to complete volume loss and overlying inflated right cranial lung lobe. On the dorsoventral projections it is clearly visualized.
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