Adenocarcinoma of the Trachea

Aleida Gonzalez
Francine Jacobson, MD

Presentation

A 78-year-old black man presented with productive cough, fever, and chest pain. The patient, previously in excellent health, reported smoking approximately 50 packs of cigarettes per year.

On physical examination, the patient was febrile and had a temperature of 101 degrees Fahrenheit. The right upper lung was dull to percussion with decreased breath sounds on auscultation.

Imaging Findings

Plain radiographs of the chest, PA and lateral

Computed tomography

Chest radiographs show right upper lobe consolidation (PA with arrow) (lateral with arrow) extending to minor fissure and inseparable from the mediastinum. Costophrenic sulci are sharp.

Computed tomography of the chest shows opacification of the right upper lobe (arrow) with multiple low density cystic regions (arrow). A right hilar mass (arrow) and paratracheal lymphadenopathy are visible.

Loculated pleural collection (arrows) is present. Subcarinal nodal enlargement (arrow) is also present.

Diagnosis

Post-obstructive right upper lobe pneumonia secondary to adenocarcinoma

Discussion

Mediastinoscopy and pleural biopsy confirmed the diagnosis of adenocarcinoma. The tumor was found to be adherent to the trachea and not resectable. Therapy included radiation therapy and antibiotics without improvement.

Adenocarcinoma accounts for more than one third of all lung carcinomas. It is usually located in the mid and peripheral lung regions. It can also occur at a site of parenchymal scarring. Spread can be to adjacent lung but adenocarcinoma also has a propensity for hilar and mediastinal nodal involvement and early distant metastatic spread to liver, bone, and central nervous system. The typical presenting radiologic finding for adenocarcinoma of the lung is a peripheral nodule or mass.

Return to the Teaching File search page
Return to Professional Education
About BrighamRAD