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.
CLINICAL CORRELATION
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.
CLINICAL PEARLS
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