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Findings:There is left lower lobe collapse and a large mass obstructing the left lower lobe bronchus. There is no significant effusion.
CT scan of the chest was performed on 1/3/96.
Scans were performed from the apices through the diaphragms with IV contrast.
There is a large heterogeneous soft tissue mass in the left hilar region. The mass encases the left main pulmonary artery and constricts the left mainstem bronchus, with associated atelectasis/consolidation of the entire left lower lobe.
Impression: Left hilar mass with endobronchial extension and associated collapse.
Diagnosis:Squamous cell cancer.
Discussion: Central lesions account for 60% of all bronchogenic carcinomas. Squamous or small cell compromise most of the central tumors but any cell type may be present. Endobronchial proliferation results in obstruction, atelectasis and/or infiltrate, which may involve segments, lobes, or an entire lung. A pneumonia may hide a central obstructive lesion on plain chest radiography. CT can aid in its discovery and further delineate possible spread of central lesions along the interstitium, lymph channels, and vascular bundles. In addition, CT may help in delineating possible direct growth into the mediastinum. CT scans are useful for hilar evaluation and detection of masses behind an infiltrate. CT cannot reliably stage tumor invasion in the mediastinum unless direct invasion or distortion of the mediastinal structures is present. As in this case, while contiguity of the mass in the mediastinum and posterior aspect of the thorax is suggested, CT cannot diagnose or exclude extension of the tumor into these regions.
References:
Haaga JR, et al; Computed Tomography and Magnetic Resonance Imaging of the Whole Body,
Edition III, St. Louis, 1994, Mosby Yearbook, Inc.
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