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

2. Case of the Month 25
Year Year 2

3. Case of the Month 25
What is your diagnosis ?

5. 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

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

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

8. 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?

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

10. 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

11. 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

12. 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.