J Thorac Cardiovasc Surg 2006;132:1219-1222
© 2006 The American Association for Thoracic Surgery
Clinical-Pathologic Conference |
Clinical-pathologic conference in general thoracic surgery: Carinal resection for endobronchial grade I neuroendocrine carcinoma
Benjamin D. Kozower, MD,
Robert Jarrett, MD,
Sanjeev Bhalla, MD,
G. Alexander Patterson, MD*
Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, Mo.
Received for publication April 25, 2006; accepted for publication June 7, 2006.
* Address for reprints: G. Alexander Patterson, MD, 3108 Queeny Tower, 1 Barnes-Jewish Hospital, St Louis, MO 63110. (Email: pattersona@wudosis.wustl.edu).
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Case Presentation
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Dr Kozower
A 20-year-old woman presented with a 2-month history of expiratory wheeze and dry cough. Her symptoms gradually worsened, and exertional dyspnea developed. She denied weight loss, fever, hemoptysis, or neurologic symptoms. Her internist prescribed bronchodilators for reactive airway disease, but her condition did not improve. A chest radiograph was abnormal, and she was referred to a thoracic surgeon.
She was in excellent health, with no significant past medical history. She took no medication and never had an operation. She is a lifetime nonsmoker and does not consume alcohol. On physical examination, she was a healthy appearing 20-year-old woman. She was afebrile and had no cervical or supraclavicular adenopathy. The results of her cardiac examination were normal. She had absent breath sounds on the right, with diminished chest wall excursion. Her extremity examination revealed no clubbing, cyanosis, or edema.
Dr Bhalla
Her initial chest radiograph is a dramatic demonstration of a mass extending into the right main-stem bronchus and distal trachea (Figure 1). The left main-stem bronchus appears uninvolved. There is complete collapse of the right lung, with herniation of the heart toward the right. A computed tomographic (CT) scan was obtained that shows an enhancing mass in the distal trachea and right main-stem bronchus (Figure 2). There are a few lymph nodes present around the airway, and there is another lymph node anterior to the mass in the region of the right hilum. The right lung is collapsed, and the mediastinum is shifted toward the right. In addition, there is a small pericardial effusion, pleural effusion, and some dilated bronchi.
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Figure 1. Chest radiograph. Anteroposterior chest radiograph shows complete opacification of the right hemothorax and volume loss. The left lung herniates over to the right. A large polypoid mass arises from the right main-stem bronchus.
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Figure 2. Chest computed tomographic scan. Noncontiguous . . . [Full Text of this Article] |
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Copyright © 2006 by The American Association for Thoracic Surgery.
