A 70 years old male patient with a long history of cough and general weakness.

A 70 years old male patient with a long history of cough and general weakness. His Chest X ray is shown in the picture below:

X-ray chest shows a mass lesion in right upper lobe (arrow), likely a bronchogenic carcinoma.

To confirm the diagnosis, CT chest was performed. CT chest (shown in the picture below A&B) shows ill-defined rounded opacity abutting the chest wall with radiating strand seen in right upper lobe with minimal necrosis within, seen in mediastinal window.

Mediastinal window (Fig C) shows aortopulmonary lymph node. A small round hypodense
metastases is seen in the right lobe of liver (Fig D)

Clinical Discussion: 
Commonest fatal malignancy in the adult males is carcinoma of the bronchus.

Carcinoma bronchus is of four types:

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

Lung tumors are classified as—

A. Primary

• Benign

• Malignant

B. Metastases

On X-ray chest, it presents as central or peripherally situated mass.

Features suggesting malignancy are nodular mass with irregular, spiculated margins; cavitating mass lesion with thick irregular or nodular walls. It may be associated with hilar enlargement or segmental or lobar collapse of the lung. 

Central bronchogenic carcinoma causes collapse of distal lobe resulting in the traditional Golden S sign; however, a more appropriate would be inverted pyramid sign. 

CT is indicated for the staging of carcinoma lung and detecting metastasis.

Lung is the most common site for metastatic disease. Most common primaries are breast, gastrointestinal tract, kidney, testes, head and neck, and bones. On imaging, it shows various patterns like multiple parenchymal nodules, lymphangitis carcinomatosis or pleural effusion.