Tuesday, April 18, 2006

Nodule and mass

This images are from an outside radiology service so the quality suffered a bit when I copied it...
This is a fairly healthy 40 y/o woman with some chronic back pain but no pulmonary or cardiac disease referred to us for a "new" pulmonary mass. She has never smoked and has had no pulmonary symptoms.
She had been told about 10-15 years ago that she had a calcified R lung nodule (left pics) and that has just been followed along. However she has had recent imaging for her back and they found that mass in the azygoesophageal recess (right pics).
Would you be concerned? Do you think the two lesions are related and what is your differential?

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Jennings said...

Well, I would be loathe to not work that up. It is right next to the esophagus and I can't tell whether it is extending from it. Maybe a radiologist out there can tell on this film whether it is a cyst or an esophogeal tumor or other mass, but I certainly can't. She is a nonsmoker but a number of causes for posterior mediastinal masses are not smoking-related.
Approach could be via endoscopic ultrasound.