Presentation
One week history of lethargy, inappetance, and coughing blood tinged fluid.
Patient Data
There is increased opacity of the left cranial lung lobe with an alveolar pattern. The caudal subsegment of the left cranial lung lobe and right middle lung lobe are affected with a lesser opacity of alveolar pattern. The cardiac silhouette is normal in size and shape. There is increased opacity in the perihilar area on the lateral projection.
Differential diagnoses for the left cranial lung lobe and additional lobe opacity include neoplasia, infectious inflammatory disease, and less likely lung lobe torsion.
Two days after the initial presentation, repeat radiographs were obtained. The alveolar pattern in the left cranial lung lobe is unchanged, and there is persistent alveolar pattern in the left caudal and right middle lung lobes. There is increased opacity in the hilar region.
On CT images, the left cranial lung lobe is filled with soft tissue and had one focal region of mineralization. The bronchi to the majority of the other lung lobes are thickened, and alveolar pattern surrounds the central airways. The right middle lung lobe has ground glass opacity. The tracheobronchial lymph nodes are enlarged.
Probable primary pulmonary neoplasia in the left cranial lung lobe with metastasis to local lymph nodes, distant bronchi and multiple lung lobes.
Case Discussion
Endoscopy and ultrasound-guided fine needle aspirate of the mass revealed only evidence of hemorrhage. On CT images, a mass was suspected in the left cranial lung lobe. Perihilar lymphadenopathy was present. A lung lobectomy was performed. The histopathologic diagnosis was anaplastic pulmonary carcinoma.
Differential diagnoses for the radiographic findings include:
Coagulopathy with hemorrhage
Granulomatous disease
- Lung lobe torsion
Pulmonary carcinomas can metastasize along airways and spread to lung lobes on both sides of the thorax. The bronchial thickening, alveolar pattern, and lymph node enlargement are suggestive of metastatic disease. The other lung lobes were not biopsied at surgery.
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