A 37-year-old woman was admitted to the hospital with a large mass in her left upper pulmonary lobe. X-rays and CT scans revealed a rounded, well-defined mass that was solid rather than a cyst. During surgery, the mass was removed but two small nodules were also found on the chest wall, indicating the mass was likely malignant. Unfortunately, biopsy results and follow-up information were unavailable. The presence of metastases suggested the mass was cancerous, so lobectomy would have been a better treatment than removing just the mass. This case highlights the importance of CT scans to correctly diagnose pulmonary masses pre-operatively.

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
Left Upper Pulmonary Lobe
Mass with Chest Wall
Metastases in a Young Lady
Prof. Abdulsalam Y Taha
College of Medicine
University of Sulaimani
2022 1

2. The Case
 A 37-years old lady was admitted to
Sulaymaniyah Teaching Hospital,
Sulaymaniyah, Region of Kurdistan,
Iraq on 25th of January 2007 because
of a big mass in the left upper
pulmonary lobe. Unfortunately, the
clinical presentations were not
available to us at the time of
preparing this short lecture.
2

3. ● CXR (PA and lateral
views) revealed a big
rounded well-defined
homogenous opacity in the
left upper lobe with a
differential diagnosis of
intact pulmonary hydatid
cyst (PHC) or pulmonary
tumour.
3
Plain Chest Radiography
Courtesy of Prof. Abdulsalam Y Taha

4. LUL Mass or Cyst
4
Courtesy of Prof. Abdulsalam Y Taha

5. However, CT scan confirmed the solid
nature of a mass rather than a cyst
5
Courtesy of Prof. Abdulsalam Y Taha

6. The patient was explored via left
posterolateral thoracotomy…6
Courtesy of Prof. Abdulsalam Y Taha

7. 7
Courtesy of Prof. Abdulsalam Y Taha

8. 8
Courtesy of Prof. Abdulsalam Y Taha

9. 9
Courtesy of Prof. Abdulsalam Y Taha

10. The mass was totally removed
but the LUL was preserved
10
Courtesy of Prof. Abdulsalam Y Taha

11. Two small chest wall nodules (?
Metastatic) were removed as
well.
11
Courtesy of Prof. Abdulsalam Y Taha

12. Comment
 Unfortunately, the biopsy result could
not be found in the medical file of the
patient. Likewise, follow up
information was also unavailable.
 The presence of chest wall metastases
was in favor of the malignant nature of
the mass. Therefore, from oncologic
point of view, left upper lobectomy
was strongly indicated rather than
(massectomy) and lung preservation.
12

13. Comment…
 This case is truly a tumour mass
radiologically simulating intact
PHC!!!
 The only way to solve the puzzle is
CT scan of the chest and surgical
exploration. Hence, the judicious
use of thoracic CT scan in doubtful
cases is greatly helpful in making a
correct preoperative diagnosis.
13