Radiographic findings: The plain film (A) in 2/98 shows a large mass overlying the left hilum, seen on the lateral chest X-ray to be in the posterior mediastinum. This lesion had been biopsied and shown to be a schwannoma (neurilemmoma). What other abnormality is also present and what are possible causes? Answer

A

A CT of the upper lungs (B) in 3/98 shows multiple round and irregularly-shaped small nodules, many of which appear to be in a centrilobular/peribronchiolar distribution. A large, irregularly-shaped mass on the right appears to be a conglomerate of small nodules. Note also the slight irregularity of the pleural surface anteriorly and laterally on the right. The subpleural opacity anteriorly on the right represents a focus of pneumonia that cleared on a subsequent film.

B. Right---------------------------------------------------Left

Clinical summary Image 1

 

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Answer: There are multiple small nodules bilaterally, predominantly in the upper lung fields. These were considered to represent infection, sarcoidosis, or pneumoconiosis. The small lung fields are due to kyphosis.

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