Fig. 4.6 PA showing multiple nodules on left (all less than 3 cm) and nodules and one mass on the right (3.4 cm)

Case 4.2

This case (Figs. 4.6 – 4.8) depicts multiple metastatic masses.

Findings: Multiple well-rounded opacities in the left lung.

Pattern: Mass (and nodules), multiple, bilateral.

Differential Diagnosis

•Malignancy

•Granulomatous disease

•Inflammation

•Benign neoplasm

•Congenital

Since there are multiple masses, malignancy (metastatic), granulomatous, and congenital become higher on the differential. Given a history of adrenal cortical carcinoma, metastatic is the primary diagnosis. Metastatic is the highest on the differential.

Bronchial Carcinoid

Bronchial Carcinoid lesions are classified from low grade (typical) to high grade (atypical). Both extremes have similar imaging features, with the majority of lesions being centrally located, well-defined, and round-to-ovoid in shape.

Fig. 4.9 PA showing large masses on right

Radiological Signs

Approximately 20% of bronchial carcinoids arise peripherally, distal to the segmental bronchi. The majority of these neoplasms are of the atypical subtype. Both typical and atypical subtypes can be associated with hilar and mediastinal lymphadenopathy; hyperplasia results from repeated post-obstructive infections or metastasis. Local nodal metastasis is more common in atypical carcinoids.

Case 4.3

Figures 4.9–4.12 show multiple large masses.

Findings: Widening of mediastinum superiorly on the right. Opacity in the retrosternal clear space seen on the lateral, heterogeneously enhancing perihilar mass post IV contrast on CT.

Pattern: Mass.

Differential Diagnosis

•Malignancy

•Granulomatous

•Inflammation, other