Centro Interdipartimentale di Radiologia Veterinaria Università degli studi di Napoli Federico II
Centro Interdipartimentale di Radiologia Veterinaria Università degli studi di Napoli Federico II
In this section of the site there are some clinical cases of the Center available to all the scientific community and users.
The x-ray examination of the chest, in LL, right and left projection, and DV, shows an oval interstitial opacity, with clear limits and with evident mass effect on the peripheral bronchi, located in the right caudal lobe and which is projected in part on the dorsal lung fields of the diaphragmatic lobes and partly on the vertebral bodies of T8, T9, T10 and T11.
This X-ray picture is compatible with primary (or, more rarely, secondary) lung cancer, lung abscess, eosinophilic or foreign body granuloma.
The ultrasound examination of the chest, performed through an acoustic window at the level of the dorsal half of the right 8th-10th intercostal space, shows a hypoechoic oval formation with sharp and hyperechoic limits.
The ultrasound examination also highlights the presence of a small pleural fluid layer (F) associated with thickening and irregularity of the contiguous pulmonary pleura. A “mirror” artifact is evident in the area circumscribed by the dotted line.
Medially, in the lesion occupying the lung space, a formation made up of hyper-reflecting lines converging towards an apex (facing left, in the image) can be seen.
The ultrasound picture appears compatible with an abscess or with a foreign body granuloma or with an expansive pulmonary formation. The central hyper-reflecting formation is compatible with a vegetable foreign body (grass arista – Ordeum Murinum) or with a bronchus with residual air and mucous content.
Echo caption intraoperative aspect: The pulmonary lesion occupies a large part of the right diaphragmatic lobe which is removed.
Macro aspect caption 1: The morphology and dimensions coincide with those detected on X-ray and ultrasound examination. The texture is meaty. The texture is meaty.
Macro aspect caption 2: When cut, a lobulated structure and a lardaceous aspect are evident. A small amount of purulent exudate is present in the interstices between the lobules. Ventro-medially, towards the hilar portion of the expansive lesion, there is a bronchus probably responsible for the hyperechoic formation highlighted by ultrasound.
The case presented confirms, as already reported in the literature, that the evidence of interstitial lung opacities, single, with clear boundaries and oval morphology, are primarily to be referred to primary neoplasms of the lung.
The relative superficiality of the pulmonary lesion allowed an ultrasound study which revealed a homogeneous hypo-anechoic echostructure of the lesion. However, the presence of air, at the interface between the expansive lesion and healthy lung parenchyma, did not allow to highlight the presence of artefacts from posterior reinforcement and therefore the possible fluid nature of the lesion. Furthermore, the presence of the central hyperechoic formation, in association with the relative hypereosinophilia, led to the hypothesis of abscess or eosinophilic granuloma or foreign body (grass arista) being considered valid.
Fine needle aspiration could have led to a definitive diagnosis although the presence of purulent exudate, within the expansive lesion, could also lead to a false diagnosis of pulmonary abscess.
Thoracotomy and pulmonary lobectomy allowed us to reach the definitive diagnosis of pulmonary adenocarcinoma.
