2. Bronchial carcinoma
• Pulmonary sarcoma and other primary malignant
neoplasms
• Benign pulmonary tumours
• Benign lymphoproliferative disorders
• Malignant lymphoproliferative disorders
• Metastases
• Evaluation of the solitary pulmonary nodule
3. Imaging features
The thoracic imaging features of bronchial carcinoma are
discussed under three headings:
-peripheral tumours
-central tumours (arising in a large bronchus at or close
to the hilum)
-and staging intrathoracic spread of bronchial carcinoma.
4. Peripheral tumours
bronchial carcinomas arise beyond the segmental bronchi, and in 30% a
peripheral mass is the sole radiographic finding.
Tumour shape and margins
-Tumours at the lung apex (Pancoast's tumours, superior sulcus
tumours) may resemble apical pleural thickening; however, the majority
of peripheral lung cancers are approximately spherical or oval in shape.
Lobulation, a sign that indicates uneven growth rates in different parts
of the tumour, is common. Occasionally, a dumb-bell shape is
encountered or two nodules are seen next to one another.
-The term corona radiata is used to describe numerous fine strands
radiating into the lung from a centralmass, sometimes with transradiant
lung parenchyma between these strands.While not specific, this sign
is highly suggestive of bronchial carcinoma
5. Central tumours
The cardinal imaging signs of a central tumour are
collapse/consolidation of the lung beyond the tumour and the
presence of hilar enlargement, signs that may be seen in isolation
or in conjunction with one another.
Collapse/consolidation in association with central
tumours Obstruction of a major bronchus often leads
to a combination of atelectasis and retention of secretions with
consequent pulmonary opacity , but collateral air drift may
partially or completely prevent these postobstructive changes.
Secondary infection may occur beyond the obstruction.
-Pleural effusion (with dyspnoea) is a feature of
adenocarcinoma
6.
Bronchial carcinoma in the left lower lobe showing
typical rounded, slightly lobular configuration. The
mass shows a notch posteriorly
7.
8. Dense hilum. The right
hilum is dense owing to a
mass superimposed directly
over it. The mass proved to
be a squamous
cell carcinoma.
9. CT demonstrating a
second primary
bronchogenic carcinoma
in the right lung in a
patient who had
undergone a previous
left pneumonectomy 7
years earlier. The new
tumour has spiculated
edges infiltrating into the
adjacent lung (corona
radiata).
10. Examples of neoplastic cavitation on chest radiography.
(A) The cavity is eccentric (large cell undifferentiated carcinoma). (B) The
inner wall of the cavity is irregular and an air–fluid level is present
(squamous cell carcinoma). (C) The cavity wall is very thin (squamous
cell carcinoma
11. Cavitating bronchogenic
carcinoma. There is
preservation of the
extrapleural fat plane at the
point of contact with the
chestwall. Although the
pleura may be involved the
chest wall is likely to be
otherwise spared.
12.
13. Cavitation may be identified in tumours of any size
and is best demonstrated by CT
Squamous cell carcinoma is the most likely cell type to
show cavitation. The walls of the cavity are of
irregular thickness and may contain tumour nodules,
but sometimes the wall has smooth inner and outer
margins. The cavity wall is usually 8-mm thick or
greater. Fluid levels are common.
CT showing cavitating squamous cell carcinoma.
The wall of the cavity is variable in thickness.
14. CT showing cavitating squamous
cell carcinoma. The wall of the
cavity is variable in thickness
15. Tumour calcification. Large bronchial carcinoma in left lower lobe
showing extensive amorphous and cloud-like calcification.
Initial examination; no treatment had been given.
16. (A) Extensive deep mediastinal invasion by primary bronchial
carcinoma. (B) On lung windows there are pulmonary
metastases.
