This Presentation is a collection of chapter 5 images from Grainger and Allison. Our aim is to study authentic data. This is only for educational purposes

1. 15 Pulmonary Neoplasms
Dr. Muhammad Bin Zulfiqar
PGR IV FCPS Services Institute of Medical Sciences / Hospital
radiombz@gmail.com
GRAINGER & ALLISON’S DIAGNOSTIC RADIOLOGY

2. • FIGURE 15-1 ■ Example of automatic
segmentation and volume calculation of a
middle lobe nodule.

3. • FIGURE 15-2 ■ Intrapulmonary lymph node.
Small ellipsoid peri-fissural nodule with
concave surfaces on CT corresponds to an
intraparenchymal lymph node.

4. • FIGURE 15-3 ■ CT demonstrates a mildly
lobulated nodule with calcification in the left
lower lobe which corresponds to a
hamartoma.

5. • FIGURE 15-4 ■ Granuloma. Focal dense solid
parenchymal calcification on chest CT indicates
previous granulomatous infection.

6. • FIGURE 15-5 ■ Pure ground-glass opacity. A focal
area of increased lung attenuation on CT through
which normal structures can be discerned is
termed ‘pure ground-glass opacity’.

7. • FIGURE 15-6 ■ Solitary part-solid ground-
glass nodule (left) with an enlarging solid
component at 3-month follow-up (right) is
indicative of malignancy.

8. • FIGURE 15-7 ■ Example of multiple pure
ground-glass nodules, one of which larger
than 5 mm.

9. • FIGURE 15-8 ■ Axial image from a contrast enhanced CT
and CT image, FDG PET image and fused image from a CT
PET study, demonstrating a PET positive right lung nodule.
(A) Lung nodule close to the right hilum with (B) increased
uptake on PET/CT corresponding to lung cancer.

10. • FIGURE 15-9 ■ Carcinoid tumour. (A) A tumour is
partially occluding the left main bronchus. (B) A well-
defined perihilar carcinoid tumour (arrows) is
demonstrated anterior to the artery to the right lower
lobe. (C) On lung windows there is only a small band of
atelectasis in the middle lobe. (D) A small peripheral
carcinoid tumour indistinguishable from a number of
other causes of a solitary pulmonary nodule.

11. • FIGURE 15-9 ■ Carcinoid tumour. (A) A tumour is partially
occluding the left main bronchus. (B) A well-defined
perihilar carcinoid tumour (arrows) is demonstrated
anterior to the artery to the right lower lobe. (C) On lung
windows there is only a small band of atelectasis in the
middle lobe. (D) A small peripheral carcinoid tumour
indistinguishable from a number of other causes of a
solitary pulmonary nodule.

12. • FIGURE 15-10 ■ (A, B)
Bronchial carcinoma in
the left lower lobe
showing typical rounded,
slightly lobular
configuration. The mass
shows a notch posteriorly.

13. • FIGURE 15-11 ■ CT demonstrating a second primary
bronchogenic carcinoma in the right lung. The patient had
undergone a previous left pneumonectomy 7 years earlier.
The new tumour has spiculated edges, infiltrating into the
adjacent lung (corona radiata).

14. • FIGURE 15-12 ■ Lung cancer mimicking pneumonia.
(A) Squamous cell carcinoma resembling pneumonia.
The entire opacity seen in the right upper zone on this
radiograph is due to the carcinoma itself. (B) Apical
adenocarcinoma of the left upper lobe of a different
patient with ground-glass attenuation margins and an
air bronchogram.

15. • FIGURE 15-13 ■ 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
(squamous cell carcinoma). (C) The cavity wall is
very thin (squamous cell carcinoma).

16. • FIGURE 15-13 ■
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 (squamous
cell carcinoma). (C) The
cavity wall is very thin
(squamous cell
carcinoma).

17. • FIGURE 15-14 ■ CT showing a cavitating squamous
cell carcinoma in the left lung. The wall of the cavity
is variable in thickness.

18. • FIGURE 15-15 ■ Calcified infectious granuloma
engulfed by lung cancer. CT shows a cluster of densely
calcified small nodules almost at the centre of a small
carcinoma.

19. • FIGURE 15-16 ■ Tumour calcification. Large
bronchial carcinoma invading the mediastinum
demonstrates coarse and cloud-like calcification.

20. • FIGURE 15-17 ■ Lobar collapse. The tumour
in the bronchus intermedius is causing partial
middle and lower lobe collapse.

21. • FIGURE 15-18 ■ Fluid-filled dilated bronchi
beyond a central obstructing carcinoma are
visible in this collapsed and consolidated
right lower lobe.

22. • FIGURE 15-19 ■ Dense
hilum. (A) The left
hilum is dense, owing
to a mass
superimposed directly
over it. (B)
Corresponding axial CT
image demonstrates
the mass lying behind
the left hilum. The
mass proved to be a
squamous cell
carcinoma.

23. • FIGURE 15-20 ■
Mediastinal invasion. CT
image (A) displayed on
mediastinal windows and
(B) displayed on lung
windows of deep
mediastinal invasion by non-
small cell lung cancer. The
tumour is obstructing the
right main bronchus and
compressing the right main
pulmonary artery; it is also
encasing the stented
superior vena cava and the
aorta. Some postobstructive
atelectasis is noted on lung
window.

24. • FIGURE 15-21 ■ MRI of a left lower lobe tumour
that has directly invaded the aortic wall, which
has altered signal adjacent to the tumour.

25. • FIGURE 15-22 ■ Chest wall invasion by a
Pancoast’s tumour. Involvement of the soft
tissues of the chest wall and the left second
rib is appreciated on the (A) axial T1-, (B)
coronal T2-weighted MRI and (C) CT images.

26. • FIGURE 15-22 ■ Chest wall invasion by a
Pancoast’s tumour. Involvement of the soft
tissues of the chest wall and the left second
rib is appreciated on the (A) axial T1-, (B)
coronal T2-weighted MRI and (C) CT images.

27. • FIGURE 15-23 ■ Cavitating bronchogenic carcinoma.
There is preservation of the extrapleural fat plane at the
point of contact with the chest wall. Although the pleura
may be involved, the chest wall is likely to be otherwise
spared.

28. • FIGURE 15-24 ■ (A)
True-positive CT for
metastatic
lymphadenopathy.
There are several
enlarged nodes in the
right paratracheal area.
The largest measured 14
mm in its short-axis
diameter (arrow). The
primary tumour was a
bronchial carcinoma in
the right lung. (B) MRI of
involved mediastinal
nodes in a patient with a
right lower lobe non-
small cell lung cancer.

29. • FIGURE 15-25 ■ False-positive CT for metastatic mediastinal
lymphadenopathy. The largest of the right paratracheal nodes
(arrow) is 15 mm in its short-axis diameter. This node proved to
be free of malignant tumour at thoracotomy. The enlargement
was due to reactive hyperplasia. The primary tumour was in
the right lower lobe.

30. • FIGURE 15-26 ■
Recurrent malignant
left hilar lymph
nodes from a small
peripheral non-small
cell lung cancer. (A)
CT demonstrates
nodes at the left
hilum. (B) The PET/CT
image confirms high
FDG uptake in
keeping with
malignant
involvement.

31. • FIGURE 15-27 ■ Kaposi’s sarcoma in two patients with
AIDS. (A) Plain chest radiograph showing extensive
pulmonary shadowing consisting of a mixture of ill-defined
rounded and band-like shadows maximal in the perihilar
regions and lower zones. (B) CT showing the peribronchial
distribution of the ill-defined pulmonary nodules. There is
interlobular septal thickening, a feature also frequently
identified on the chest radiograph.

32. • FIGURE 15-28 ■ Hamartoma of the lung. (A, B)
Round, completely smooth, hamartoma in a 57-
year-old asymptomatic man. There is typical coarse
popcorn calcification in this lesion, which is
unusually large.

33. • FIGURE 15-29 ■ Primary
pulmonary lymphoma.
(A) CT imaging
demonstrates multiple
areas of consolidation.
This appearance had
been very slowly
progressive over several
years. (B) Chest X-ray
shows an area of
consolidation in the right
upper lung zone in a
patient with primary
pulmonary Hodgkin’s
lymphoma.

34. • FIGURE 15-30 ■ Pulmonary involvement by
lymphocytic lymphoma showing multiple
pulmonary masses.

35. • FIGURE 15-31 ■ Pulmonary involvement by non-
Hodgkin’s lymphoma. This appearance closely
resembles lymphangitis carcinomatosa, with
widespread nodules and thickened septal lines.

36. • FIGURE 15-32 ■ Typical pulmonary metastases.
Multiple welldefined spherical nodules in the
lungs. Rib metastases with associated soft-tissue
swelling are also present (arrows). In this case the
primary tumour was a synovial cell carcinoma.

37. • FIGURE 15-33 ■ Pulmonary metastases. CT
demonstrating a single peripheral metastasis (arrow).
There were multiple lesions at other levels. The volume
loss and scarring in the left lung is secondary to previous
resection of the primary bronchogenic carcinoma.

38. • FIGURE 15-34 ■ Irregular pulmonary
metastases. Metastatic adenocarcinoma from
an unknown primary. The nodules are
irregular in outline. A large left pleural
effusion is also present.

39. • FIGURE 15-35 ■ Unilateral lymphangitic carcinomatosis.
Carcinoma of the bronchus, showing thickened septal lines
and nodules confined to the right lung.

40. • FIGURE 15-36 ■ Bilateral lymphangitic
carcinomatosis. Bilateral thickened septal lines,
together with widespread nodulation of the
lungs, are seen. The primary tumour in this 71-
year-old woman was presumed to be a bronchial
carcinoma (a diagnosis based on sputum
cytology).

41. • FIGURE 15-37 ■ High-resolution CT of lymphangitic
carcinomatosis. Note the variable thickening of the interlobular
septa and the enlargement of the bronchovascular bundle in the
centre of the secondary pulmonary lobules. The polygonal shape of
the walls (septa) of the secondary pulmonary lobules is particularly
well shown anteriorly. The pulmonary nodule is due to a discrete
metastasis, a relatively frequent finding in this condition.