Ann Thorac Surg 2003;75:597
© 2003 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Unusual cause of a pulmonary mass on computed tomographic scan of the thorax
Lognathen Balacumaraswami, FRCSa,
Pradeep Narayan, FRCSa,
Mark Callaway, MRCP, FRCRb,
Christopher P. Forrester-Wood, FRCSa*
a Department of Cardiothoracic Surgery, Bristol Royal Infirmary, Bristol, United Kingdom
b Department of Radiology, Bristol Royal Infirmary, Bristol, United Kingdom
* Address reprint requests to Mr Forrester-Wood, Department of Cardiothoracic Surgery, Thoracic Surgery Level 06, Bristol Royal Infirmary, Upper Maudlin St, Bristol BS2 8HW, United Kingdom.
e-mail: evans.christine{at}ubht.swest.nhs.uk
A 49-year-old male smoker with emphysema presented with recurrent cough and black sputum. A chest radiograph showed a well-demarcated round lesion in the right lower zone measuring 2 cm in diameter and obscuring the right heart border, but no evidence of lobar collapse (Fig 1, arrowheads).
A computed tomographic scan of thorax reviewed on lung windows showed a well-defined 3-cm mass with a spiculated anterior border and a halo-like linear opacification or a "tail" adjacent to the "tumor" in the right lower lobe (Fig 2).
The mass was adjacent to dilated bronchi, raising the possibility of an aspergilloma in an old fibrotic area or, given the nature of the lesion, a primary bronchial carcinoma.
A right lower lobectomy was performed. Histopathologic examination of the specimen revealed an area of stellate scarring in the inferior pole of the right lower lobe, with an area of pleural fibrosis, which draws in the adjacent lung associated with minimal inflammation.
Figure 2 illustrates that rounded atelectasis (infolded lung) may mimic the radiologic features of a primary bronchial carcinoma.
