Presentation
Altered conscious state. Palpable back mass.
Patient Data
Cavitating lesion with surrounding consolidation in the superior segment of the right lower lobe. The underlying 10th posterior rib appears to be involved. Left lung clear.
Large cavitating mass within the right lower lobe measuring 7.9 cm (trans) x 8.6cm (ap) x 8.5cm (cc). There is associated rib destruction of the posteriorly adjacent 9th-11th ribs. Pathological fracture of the posterior aspect of the right 11th rib. The mass extends into the muscles and subcutaneous tissues of the right posterior chest wall.
Small bilateral pleural effusions, tracking into the oblique fissures. Minor bibasal and lingular atelectasis. Multiple prominent mediastinal lymph nodes the largest measuring 1.2 cm diameter. No significant axillary lymphadenopathy. Background emphysematous change, including subpleural blebs.
Conclusions: Cavitating mass within the right lower lobe with posterior adjacent rib destruction, right posterior chest wall soft tissue infiltration and pathological fracture of the right posterior 11th rib, compatible with squamous cell carcinoma. Prominent mediastinal lymph nodes measuring up to 12 mm diameter.
Case Discussion
The patient went on to have a biopsy.
Pathology
FNA Right Chest Wall: Squamous cell carcinoma.
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