A Lung Mass Causing Cardiovascular Impairment

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 Lungs: o WW 1000 to 1500HU o WL -600 to -700HU  Mediastinum, Hilum: o WW 350 to 500HU o WL 30 to 50HU.

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A Lung Mass Causing Cardiovascular Impairment Daniel Menzies, MB, ChB, MD, John Gosney, MB, ChB, MD, Mark Elias, MB, BCh, Stephen Kelly, BM, BCh, Mark Steel, MBBS, PhD CHEST Volume 136, Issue 6, Pages 1682-1685 (December 2009) DOI: 10.1378/chest.09-0008 Copyright © 2009 The American College of Chest Physicians Terms and Conditions

Figure 1 Posteroanterior chest radiograph demonstrating a large mass occupying the majority of the right hemithorax with associated displacement of the heart and mediastinum. The medial border of the mass is visible behind the cardiac silhouette (arrows) making diaphragmatic displacement or herniation a less likely explanation. The upper mediastinum is normal in dimension. CHEST 2009 136, 1682-1685DOI: (10.1378/chest.09-0008) Copyright © 2009 The American College of Chest Physicians Terms and Conditions

Figure 2 CT scan images of the thorax clearly show significant compression of the inferior vena cava and right side of the heart by a large tumor the image of which was not enhanced with contrast medium compared with the precontrast localizer. The mass is notably heterogeneous in appearance, with areas of low-attenuation signal (dashed arrows), admixed with high-density islands of presumed calcification (solid arrows). Although not shown, the liver was displaced inferiorly, and there was a small associated pleural effusion. CHEST 2009 136, 1682-1685DOI: (10.1378/chest.09-0008) Copyright © 2009 The American College of Chest Physicians Terms and Conditions

Figure 3 The excised mass, 18 cm in maximal diameter, consisting of large, glassy lobules separated by thin fibrous bands. CHEST 2009 136, 1682-1685DOI: (10.1378/chest.09-0008) Copyright © 2009 The American College of Chest Physicians Terms and Conditions

Figure 4 Medium-power photomicrograph showing the characteristic bronchiolar-like structures and adipose tissue at the margin of one of the lobules of mature cartilage that made up the bulk of the lesion (hematoxylin-eosin, original ×100). CHEST 2009 136, 1682-1685DOI: (10.1378/chest.09-0008) Copyright © 2009 The American College of Chest Physicians Terms and Conditions