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

Normal CXR 7 years ago
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TheCommonVein.net

Normal CXR 7 years ago
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2 years ago presented with dyspnea for 2 weeks
CXR

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

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- 2 Months later
- right sided lung mass pleural involvement, and extensive adenopathy with
- RUL Mass
-
RUL infiltrate increased CT 2 months later
Courtesy Paul Kohanteb MD TheCommonVein.net- RUL Mass Mass is Bronchocentric with Obstruction
RLL Bronchocentric mass increased in size
CT 2 months later
Courtesy Paul Kohanteb MD TheCommonVein.netRLL Mass
-
RLL Bronchocentric mass increased in size
CT 2 months later
Courtesy Paul Kohanteb MD TheCommonVein.netBilateral fissural thickening CT 2 months later
Courtesy Paul Kohanteb MD TheCommonVein.netThickened Interlobular SeptaInterlobular septal thickened in the RLL CT 2 months later
Courtesy Paul Kohanteb MD TheCommonVein.net - Lymphadenopathy
Mediastinal and hilar adenopathy
Courtesy Paul Kohanteb MD TheCommonVein.netLymphadenopathy
Mediastinal and hilar adenopathy
Courtesy Paul Kohanteb MD TheCommonVein.netSpleen and Liver Negative
Normal appearing spleen
Courtesy Paul Kohanteb MD TheCommonVein.net - PET positivity suggesting lung cancer with pleural involvement
- RUL Mass Hyperintense and Lymphadenopathy
PET positive RUL mass pleura and lynph nodes bilaterally
Courtesy Paul Kohanteb MD TheCommonVein.net- RLL Mass Hyperintense
PET positive RLL mass pleura and lynph nodes bilaterally
Courtesy Paul Kohanteb MD TheCommonVein.netLymphadenopathy
PET positive foregut lymph nodes
Courtesy Paul Kohanteb MD TheCommonVein.net1 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.
- extensive hypermetabolic activity associated with
- RLL Mass Hyperintense
- 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.
- started on Methotrexate
-
1 year ago
- RUL Mass Scar Like
-
RUL mass hass shrunk
Courtesy Paul Kohanteb MD
TheCommonVein.netRLL Mass Poorly Visualized Because of New Effusion
RLL mass hass shrunk
Courtesy Paul Kohanteb MD
TheCommonVein.netFissures Resolved and New Effusion
New Effusion
Courtesy Paul Kohanteb MD
TheCommonVein.netLymphadenopathy Improved
Decreasedm Adenopathy
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TheCommonVein.net -
Current on Methotrexate and Prednisone
- RUL Mass Scar Like
-
RUL mass remains scar like
Courtesy Paul Kohanteb MD
TheCommonVein.netRLL Mass Poorly Visualized Because Complex Effusion
RLL mass persists but smaller
Courtesy Paul Kohanteb MD
TheCommonVein.net -
Fissures Resolved
RLL mass hass shrunk
Changes in the Fissures have Resolved
Courtesy Paul Kohanteb MD
TheCommonVein.netImproving Complex Effusion
Effusion smaller but persists and is complex
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TheCommonVein.net - Lymphadenopathy Improved
Decreased Adenopathy
Courtesy Paul Kohanteb MD
TheCommonVein.netLymphadenopathy Improved
Decreased Adenopathy
Courtesy Paul Kohanteb MD
TheCommonVein.net