March 2013 Imaging Case of the Month

Michael B. Gotway, MD*

Sudheer Penupolu, MD^‡

Jasminder Mand, MD^†

*Department of Radiology, Mayo Clinic, Arizona

^‡Fellow, Pulmonary Medicine, Mayo Clinic Arizona

^†Pulmonary and Critical Care Medicine, Maricopa Medical Center

Clinical History: A 54-year old Hispanic woman with no significant past medical history presented with complaints of cough and worsening dyspnea. She was in her usual state of health until 4-5 weeks prior to presentation when she started noticing gradually worsening dyspnea on exertion. She reported a dry cough initially which subsequently became productive of whitish, mucoid sputum. The patient denied chest pain, sore throat, sick contacts, or recent travel history. A chest x-ray was performed (Figure 1).

Figure 1. Frontal (A) and lateral (B) chest radiography.

Which of the following statements regarding the chest radiograph is most accurate?

1. The chest radiograph shows bilateral linear and reticular abnormalities
2. The chest radiograph shows nodular interstitial thickening
3. The chest radiograph shows multiple, bilateral circumscribed nodules
4. The chest radiograph shows mediastinal and hilar lymph node enlargement
5. The chest radiograph shows mediastinal widening

Reference as: Gotway MB, Penupolu S, Mand J. March 2013 imaging case of the month. Southwest J Pulm Crit Care. 2013;6(3):112-24. PDF

Medical Image of the Week: Squamous Cell Carcinoma Presenting as an Endobronchial Mass

Figure 1. CT axial cut showing large endobronchial mass (arrow) at the junction of the right upper lobe bronchus and bronchus intermedius.

Figure 2. Endobronchial lesion with view from trachea before (Panel A) and after (Panel B) removal by APC.

A 65 year old woman with previously diagnosed emphysema presented with two weeks of worsening dyspnea on exertion. CT scan of the chest showed a 14mm x 12mm irregular endobronchial lesion (arrow) occluding the bronchus intermedius. Right-sided compensatory “ball-valve” emphysematous changes are noted.  Right posterior atelectasis is also seen.  Endobronchial biopsy revealed squamous cell carcinoma. The patient later underwent palliative argon plasma coagulation (APC) therapy with removal of the tumor (Figure 2) with re-expansion of the right middle lobe.

Sage P. Whitmore, MD; James L. Knepler, Jr. MD and Linda Snyder, MD

Division of Pulmonary and Critical Care Medicine

Arizona Respiratory Center

University of Arizona

Tucson, Arizona

Reference as: Whitmore SP, Knepler JL Jr, Snyder L. Medical image of the week: squamous cell carcinoma presenting as an endobronchial mass. Southwest J Pulm Crit Care 2013;6(2):85-6. PDF