Case of the Month 25 July 2017 History:

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Presentation transcript:

Case of the Month 25 July 2017 History: 67 year old man with shortness of breath and a significant smoking history

Case of the Month 25 Year 1 Year 2

Case of the Month 25 What is your diagnosis ?

Case of the Month 25 July 2017 History: Question: 67 year old man with shortness of breath and a significant smoking history Question: What are the key findings on CT? Authors: O Kelly, DJ Murphy, JD Dodd, St Vincent’s University Hospital, Dublin, Ireland

Case of the Month 25 Combined pulmonary fibrosis emphysema phenotype Upper lobe centrilobular emphysema Honeycombing, reticulation and traction bronchiectasis in the lingula

Case of the Month 25 Year 1 Year 2 Question: What is the key finding?

Case of the Month 25 Enlarging spiculated opacity in the left upper lobe at the interface between normal and fibrotic lung What diagnostic test could be performed next?

Case of the Month 25 CT guided lung biopsy Note further nodule enlargement

Squamous cell lung cancer on background pulmonary fibrosis Case of the Month 25 Diagnosis Differential Diagnosis Primary lung cancer Metastases Diagnosis Squamous cell lung cancer on background pulmonary fibrosis

Lung Cancer in Pulmonary Fibrosis Case of the Month 25 Discussion Lung Cancer in Pulmonary Fibrosis 10 fold increased incidence of lung cancer in patients with pulmonary fibrosis Approximately 2/3 of tumours are found at the interface between fibrotic and normal lung Less common within honeycombed lung Often difficult to discern initially Can appear stellate/oval or bandlike, not typical spherical shape

Lung Cancer in Pulmonary Fibrosis Case of the Month 25 References Lung Cancer in Pulmonary Fibrosis Yoshida R, Arakawa H, Kaji Y et al. Lung Cancer in Chronic Interstitial Pneumonia: Early Manifestation From Serial CT Observations. AJR 2012; 199:85-90 Kishi K, Homma S, Kurosaki A et al. HRCT findings of lung cancer associated with idiopathic pulmonary fibrosis. J Comput Assit Tomogr 2006; 30:95-99.