A 60 year old man presents with cough not responding to antibiotics...

The x ray shown in the picture above is of a 60 year old man who presented with a history of cough that was not responding to antibiotics and cough syrups.

X Ray Description: X-ray chest shows a mass lesion measuring 6 cm in diameter in left lower zone of which the margins are not smooth, finding suggestive of carcinoma lung, however, needs confirmation on CT chest.

Case Follow Up : The patient was subjected to CT chest (see the picture below) shows moderately
enhancing irregular mass lesion measuring 5 × 6 cm in the superior segment of Left lower lobe and lingula. Feeding vessel is also seen. Multiple areas of necrosis are seen within. There is central cavitation and air fluid level. Surrounding lung shows infiltration. Multiple pretracheal, carinal, and subcarinal lymph nodes are seen measuring 11–17 mm.

Diagnosis of carcinoma lung was made.
Mass lesion seen in the lung after the age of 40 years (age of this patient is 60 years) should be considered malignant unless proved otherwise.

Clinical Discussion:
Carcinoma lung is the most common fatal malignant neoplasm in men and it has now surpassed breast cancer as the leading cause of cancer death in women. Most lung cancer deaths are directly attributable to cigarette smoking. The risk of lung cancer occurrence is related to the number of cigarettes smoked, the number of smoking years, the age at which smoking began, and the depth of inhalation. The risk decreases with cessation of smoking but never completely disappears. Other etiological factors including genetic and occupational factors and the presence of concomitant disease in the lung may play a role in the development of lung cancer.

Clinical Presentations: Patients with central tumors obstructing a major bronchus may present with cough, wheezing, hemoptysis and lung infection. Local intrathoracic spread may result in left laryngeal nerve paralysis, pleural or chest wall pain, symptoms related to superior vena cava obstruction or Pancoast neoplasm.

Histologically, the common cell types of lung cancers include

1. adenocarcinoma, 
2. squamous cell carcinoma, 
3. small cell carcinoma and 
4. large cell undifferentiated carcinoma.

The radiological appearance depends on intrathoracic spread including bone destruction, pleural effusion, hilar and mediastinal lymphadenopathy, lung nodule in the contralateral lung, mediastinal mass, pleural nodularity or nodular thickening of the interlobular septa.