Central mass (squamous cell carcinoma) with left upper lobe collapse

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Radiological Signs of Chest Disorders (Part 1)

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Central mass (squamous cell carcinoma) with left upper lobe collapse Central mass (squamous cell carcinoma) with left upper lobe collapse. (A) Frontal radiograph demonstrates hazy left upper lung zone opacity with a concave border (black arrow) which is consistent with left upper lobe collapse. There is also a convex border-forming structure projecting over this same area, suggesting an underlying mass, which also results in tracheal compression (white arrows). (B) Lateral radiograph demonstrates concave border of the collapsed left upper lobe with anterior displacement of the major fissure (black arrow). Convex border of the underlying mass is seen more posteriorly (white arrow). The lateral view is somewhat limited by rotated positioning. (C) Axial contrast-enhanced chest CT at the level of the aortic arch demonstrates a heterogeneous centrally located mass (white arrow) abutting the aorta. There is atelectatic lung anterior to the mass, which contains normal appearing pulmonary vessels (black arrows), although the heterogeneous attenuation of this lung suggests post obstructive pneumonitis or pneumonia. (D) Coronal CT section with lung widows demonstrates high-grade stenosis of the left main bronchus, and the left upper lobe bronchus is not visualized, as it is completely occluded. Note tracheal compression by the medially displaced aortic arch. (E) Coronal CT section in soft tissue windows demonstrates the collapsed left upper lobe responsible for the concave shadow on the frontal chest radiograph. Normal pulmonary vessels are annotated (black arrowheads). Heterogeneous attenuation of this lung again suggests post obstructive pneumonitis or pneumonia. (F) Another coronal CT section in soft tissue windows more posteriorly than (E) demonstrates the mass responsible for the convex border on the radiographs. Note the lack of normal pulmonary vessels in the mass as compared to the atelectatic lung in (E). Source: Cardiothoracic Imaging, Introduction to Diagnostic Radiology Citation: Elsayes KM, Oldham SA. Introduction to Diagnostic Radiology; 2015 Available at: https://accessmedicine.mhmedical.com/DownloadImage.aspx?image=/data/books/1562/elsayes_ch04_fig-c10-03.png&sec=95876677&BookID=1562&ChapterSecID=95876454&imagename= Accessed: November 12, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved