Imaging of the week

65 yr old female ,presented with neck swelling –3 months loss of appetite,weight – 3 months no other significant symptoms

O/E PR -86/mt BP- 120/80 mm hg CVS,RS,ABD.,CNS.,--NAD

CXR –PA VIEW WELL CENTRED INSPIRATORY FILM ADEQUATELY PENETRATEDTRACHEA –SHIFTED TO LT.HOMOGENOUS OPACITY –RT.NECK AND RT.APEX i.e, ‘CERVICOTHORACIC SIGN’ NODULAR OPACITIES- WELL DEFINED MULTIPLE

,RANDOMLY DISTRIBUTEDi.e, ‘CANNON BALL’ MASSESELEVATED RT.HEMIDIAPHRAGM

“Cervico thoracic sign” -due to neck mass extending into superior mediastinum or the other way round

-most common causes thymoma teratoma thyroid tumors lymphoma

CT FINDINGS

HOMOGENOUS OPACITY PRESENT IN THE SUPERIOR MEDIASTINUM -RIGHT SIDE

NODULAR OPACITIES- WELL DEFINED MULTIPLE ,RANDOMLY DISTRIBUTED MORE AT THE BASE

IMPRESSION THYROID SWELLING EXTENDING INTO

THE SUPERIOR MEDIASTINUM

MULTIPLE METASTASES INVOLVING BOTH

LUNG FIELDS

RIGHT DIAPHRAGMATIC PALSY

PATTERNS OF SECONDARIES LUNG

A:PARENCHYMAL NODULES -SOLITARY - MULTIPLE - ‘CANNON BALL’ MASSES

B:INTERSTITIAL THICKENING -LYMPHANGITIC CARCINOMATOSIS

C:PULMONARY HYPERTENSION & INFARCTION

D:PLEURAL EFFUSION

“Cannon ball masses”

-tumor emboli deposited in the interstitium -equal restriction of growth on all sides by alveoli - leading to well defined circular masses

Differential diagnosis for multiple nodular opacities A; Tumors -benign-hamartomas -malignant –lymphomas ,secondaries B;Vascular lesions - thromboemboli /septic emboli with organised infarcts C;Collagen vascular diseases -wegener’s ,rhematoid nodules D;Inflammatory granulomas - fungal,bacterial,parasites ,sarcoidosis

Tumours causing secondaries lung kidney thyroid colorectum breast liver head and neck melanoma prostate uterus,cervix sarcomas

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