D. Pleural Effusion
Ans:A. Lung Tumor.
Chest radiograph showing a large irregular tumour mass (large arrows) in the right upper lobe with right hilar lymphadenopathy (small arrows). The thickened right paratracheal stripe (arrowheads) also indicates enlarged paratracheal nodes. Note the presence of a pleural metastasis in the left mid zone (white arrow).
Primary lung carcinoma
- The irregular border is suggestive of an infiltrating lesion.
- The bulging right hilum represents enlarged hilar lymph nodes due to metastatic involvement.
- Thickened paratracheal stripe indicates enlarged right paratracheal lymphadenopathy.
- Other possible radiological features of lung carcinoma not seen in this patient include:
- Bony erosion – due to haematogenous metastases to bone
- Pleural effusion – due to lymphatic obstruction by primary tumour or tumour involvement of the pleura
- Lobar collapse – due to obstruction by primary tumour or enlarged hilar lymph nodes
- Cavitation – indicating tumour necrosis, most common in squamous cell carcinoma
- If a lung mass is identified on chest radiograph, the following features may help to differentiate malignant tumour from benign lesion (such as granuloma):
- Margin – spiculated border is more suspicious of malignancy
- Intra-lesional calcification – presence of coarse calcification favours benign lesion
- Size – large lesion is suspicious of malignancy
- Any associated lymphadenopathy(hilar/mediastinal) and bony erosion– suggests metastatic involvement by malignant lung tumour