CXR Case 057
An 89 year old man presents with increasing tiredness and lethargy
Describe and interpret this CXR
CHEST X-RAY INTERPRETATION
There is a large, rounded mass in the right upper zone.
There are multiple small rounded opacities in the right mid and lower zones.
The aorta is unfolded. Bones look normal.
This is a large cancer originating within the lung parenchyma with smaller ipsilateral metastases; bone scan revealed multiple bony metastases.
Fine needle aspirate (FNA) revealed a poorly differentiated large cell carcinoma. He had a raised serum PSA but no definitive prostate immunohistochemical stains.
The concave angle(s) between the mass and the pleura indicate that this mass has originated from the lung.
A convex angle would usually lend toward a pleural based origin.
Prof Fraser Brims Curtin Medical School, acute and respiratory medicine specialist, immediate care in sport doc, ex-Royal Navy, academic| Top 100 CXR | Google Scholar | ICIS Course ANZ