A 63-year-old man had a 6-month history of dyspnea, cough, and expectoration, and weight loss. Physical examination of the patient revealed largely suppressed respiratory sounds and markedly dull percussion sounds over the left lung. The left lung showed complete opacification on conventional radiography and absent ventilation with only rudimentary perfusion on scintigraphy. Subsequently performed electron-beam computed tomographic (CT) scanning (Figs. 1–5) demonstrated a large tumor in the left lower lobe with in-filtration of the mediastinum. The tumor compressed and partly obstructed the bronchial system and pulmonary arteries. In addition, the tumor invaded the left pulmonary veins with continuous extension into the left atrium up to the level of the mitral valve, which was confirmed by transesophageal echocardiography (Fig. 6). Bronchoscopic biopsy revealed an adenocarcinoma with necrotic degeneration, from which the patient died a few weeks later.
Fig. 1 Contrast-enhanced electron-beam computed tomographic scan, axial section, at the level of the pulmonary bifurcation. A large tumor mass is seen in the left lower lobe, left hilum, and mediastinum, with encasement of the left pulmonary artery (arrows).
Ao = aorta; PA = pulmonary artery; Tm = tumor
Fig. 2 Contrast-enhanced electron-beam computed tomographic scan, axial section. Tumor (Tm) portions are depicted in the area of entrance from the left superior pulmonary vein into the left atrium (arrows).
Fig. 3 Contrast-enhanced computed tomographic scan, axial section. There is a clear view of the large tumor (Tm) cone extending from the left inferior pulmonary vein (arrows) into the left atrium (LA).
Fig. 4 Contrast-enhanced electron-beam computed tomographic scans show multiplanar reformations in an angulated sagittal orientation. The reformations show the full extent of the tumor in the left atrium A) in the area of entrance to the left superior pulmonary vein (arrows), and B) in the left inferior pulmonary vein (arrows).
Ao = aorta; LA = left atrium; LV = left ventricle; Tm = tumor
Fig. 5 Electrocardiographically triggered contrast-enhanced electron-beam computed tomographic scan along the approximated long axis of the heart during early diastole. The image provides good visibility of the tumor prolapsing from the left atrium into the left ventricle through the open mitral valve.
LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle; Tm = tumor
Fig. 6 Transesophageal echocardiography impressively confirms prolapsing of the tumor from the left atrium into the left ventricle.
Ao = aorta; LA = left atrium; LV = left ventricle; Tm = tumor
Footnotes
Address for reprints: Alexander Lembcke, MD, Institut für Radiologie, Universitätsklinikum Charité, Campus Charité Mitte, Humboldt-Universität zu Berlin, Schumannstrasse 20/21,10098 Berlin, Germany
e-mail: Alexander.Lembcke@gmx.de