Lung cancer progression - Pre-treatment

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Lung cancer progression - Pre-treatment

  • This long term smoker presented with a cough and finger clubbing
  • A large lobulated mass is seen in the region of the right lung hilum - proven to be a cancer following biopsy
  • CT showed it was non-operable and chemotherapy was offered

Lung cancer - Post-chemotherapy

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Lung cancer - 3 months post-chemotherapy

  • The mass can no longer be seen clearly indicating a good response to treatment
  • The raised position of the right hemi-diaphragm is a sinister feature and implies injury or invasion of the phrenic nerve leading to phrenic nerve palsy

Lung cancer - 4 months after chemotherapy

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Lung cancer - 4 months after chemotherapy

  • The mass has recurred
  • Consolidation seen distal to the mass (asterisks) may be due to disease infiltration, lymphangitis or possibly infection
  • This consolidation is demarcated inferiorly by the horizontal fissure indicating it is mainly in the right upper lobe
  • The right hemi-diaphragm is higher than on the previous image indicating increasing volume loss of the right lung
  • Blunting of the right costophrenic angle indicates a pleural effusion
  • Bulging of the left mediastinal contour indicates progression of disease through the mediastinum to the contralateral side

Lung cancer - Disease progression

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Lung cancer - Disease progression

  • Another month later the mass has again increased in size
  • The horizontal fissure is displaced superiorly - indicating the right upper lobe has lost volume due to occlusion of airways
  • Increased density (whiteness) under the level of the diaphragm indicates the presence of pleural fluid – this is the typical appearance of a subpulmonic effusion (fluid located between the lung base and hemidiaphragm)

Lung cancer - Disease progression

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Lung cancer - Disease progression

  • After a further month the mass and effusion have again increased in size
  • There is now a contralateral pleural effusion