A 72 year old man presents with recurrent falls and pains in his chest.
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Describe and interpret this CXR and CT chest
There is a lobulated ~5cm tumour just lateral to and above the left hilum. There are several healing fractures to the left ribs (8th and 9th) on the left side. The left clavicle has some deformity indicating a healed fracture.
CT demonstrates the large soft tissue mass in the left upper lobe. Note the subcutaneous emphysema after the CT-guided percutaneous biopsy
This is probably a large primary lung cancer.
There is no obvious bony destruction suggestive of bony metastases in the ribs.
Cerebral metastases as a cause of the falls should be investigated
Approximately 7-10% of patients diagnosed with non small cell lung cancer have brain metastases at the time of diagnosis.
Between 20-40% may develop metastases over the course of their illness.