Presentation
Glottic SCC with previous laryngectomy. Has esophageal strictures, proceeded to dilation procedure today. NGT inserted for supplementary feeds. Assess position
Patient Data
The nasogastric tube is projected over the gastric body, approximately 10cm from the gastro-esophageal junction. Surgical clips noted projected over the neck, mediastinum, left midzone and left axilla. There is interval reaccumulation of the left sided pleural effusion with associated collapse and consolidation of the left lower and mid-zones of the lung. Loss of the AP window with focal opacification may relate to hilar mass or lymphadenopathy.
Bowel gas pattern is normal. Unremarkable skeletal structures.
Almost the entire left hemithorax shows a peripheral rind of intense FDG uptake with SUVmax of 18. On CT there is grossly thickened nodular pleura with adjacent masses. There is a large pleural effusion, as noted previously with adjacent compression atelectasis and soft tissue masses, leaving perhaps 20% of the lung aerated.
The right hemithorax shows approximately 8 soft tissue masses. The largest is adjacent to the upper mediastinum about 35mm diameter with SUVmax 10.5.
There is right hilar lymphadenopathy showing increased FDG uptake. An NG tube is seen.
Case Discussion
The aortopulmonary (AP) window is a key review area on chest x-rays as it can hide potentially serious pathology.
The AP window normally has a concave lateral border. A straight lateral border can be considered normal if unchanged from the previous chest x-ray. A newly straightened or convex lateral border is considered abnormal and has a number of causes:
- mediastinal lymphadenopathy (most common)
- prominent mediastinal fat (normal variant)
- aortic or bronchial artery aneurysms
- malignancy, e.g. nerve sheath tumor
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