The Common Vein

52y.o. male, with PMH tobacco use (60py), COPD, spinal surgery, sarcoidosis

7 years ago asymptomatic

2 years ago presented with dyspnea for 2 weeks

CXR

Emphysematous changes. Multifocal patchy opacities
with consolidation in the right upper lung concerning for multifocal
pneumonia.

CT showed

methotrexate

 

• 2 Months later
  • right sided lung mass pleural involvement, and extensive adenopathy with
  • RUL Mass

  • 

     

    • RUL Mass  Mass is Bronchocentric with Obstruction

    

     

    RLL Mass 

  • 

    Fissures Involved

    Bilateral fissural thickening CT 2 months later
    Courtesy Paul Kohanteb MD TheCommonVein.netThickened Interlobular Septa

    

     

  • Lymphadenopathy

    

    Lymphadenopathy

    

    Spleen and Liver Negative

    

  • PET positivity suggesting lung cancer with pleural involvement
• RUL Mass Hyperintense and Lymphadenopathy 

  

   

  • RLL Mass Hyperintense

    

    Lymphadenopathy

    

    1 year prior PET scan showed

    • extensive hypermetabolic activity associated with
      extensive predominantly
    • pleural-based malignancy in
      • all lobes of thebilateral lungs with
      • some parenchymal involvement and
      • interlobularseptal thickening concerning for
        • lymphangitic carcinomatosis,
    • lymphadenopathy and bilateral pleural effusions which have overall progressed.
• Pathology form an EBUS 2years ago
  • revealed non-caseating granulomata without malignancy,
  • consistent with sarcoidosis.
    • started on Methotrexate
      • dyspnea worsened .
      • Prednisone 15mg, now down to 10mg.

  • 1 year ago

  • RUL Mass Scar Like

  • 

    RLL Mass Poorly Visualized Because of New Effusion

    

    Fissures Resolved and New Effusion

    

    Lymphadenopathy Improved

    

     

  • Current on Methotrexate  and Prednisone

  • RUL Mass Scar Like

  • 

    RLL Mass Poorly Visualized Because Complex Effusion

    

     

  • Fissures Resolved

    

    Improving Complex Effusion

    

     

  • Lymphadenopathy Improved

    

    Lymphadenopathy Improved