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• W2980866628 abstract "SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Left upper lobe opacities carry wide differentials including pneumonia, segmental or subsegmental atelectasis, dilated aortic aneurysm with or without rupture or lung cancer. Occasionally chest radiograph can pose an immense challenge for clinicians to distinguish an aortic pathology from a primary lung etiology. We present a case of an elderly male who was referred to the pulmonary clinic for work up of left upper lobe mass. CASE PRESENTATION: 80 year-old male with history of hypertension, atrial fibrillation on warfarin, former smoker presented to the pulmonary clinic after he was referred by his primary care physician (PCP) for evaluation of left upper lobe mass. He was recently seen by his PCP for worsening dyspnea on exertion and productive cough for the last one month. Chest Xray showed a focal mass-like density within the left suprahilar region with mass effect and displacement of trachea suspicious for lung malignancy versus pneumonia (Figure 1). He was started on antibiotics for pneumonia and referred to the pulmonary clinic. He denied any symptoms of chest pain, hemoptysis or weight loss. Review of systems was negative except for mild left shoulder discomfort. Laboratory studies were within normal limits except for subtherapeutic INR. No reported family history of malignancy. No prior imaging available for comparison. Computed Tomography Angiography (CTA) Chest was ordered to rule out aortic involvement which revealed hyper attenuating mural thrombus within a 9.0 x 8.6 x 10.3 cm pseudoaneurysm of the aortic knob without any periaortic fluid to suggest aortic rupture or dissection. The brachiocephalic trunk and left common carotid artery were normal in caliber but there was compression of the left subclavian artery and left brachiocephalic vein with formation of venous collaterals (Figure 1). The pseudoaneurysm was deemed to be chronic in duration. CT abdomen showed infarction of the left kidney and renal duplex ultrasound confirmed lack of blood flow within the parenchyma likely due to thromboembolism. He was admitted to the hospital for parenteral anticoagulation. Cardiothoracic surgery was consulted. Patient deferred surgical management owing to high peri-operative mortality. DISCUSSION: Ascending aortic aneurysms are often asymptomatic but if enlarged can present with symptoms such as shoulder or chest pain, dyspnea and hoarseness. There have been case reports where the patient was misdiagnosed with left lung cancer with aortic invasion. CTA Chest remains sensitive and preferable means of diagnosing aortic aneurysm. CONCLUSIONS: Misdiagnosing an aortic pathology for a primary lung malignancy can result in catastrophic outcomes. Dilated ascending aortic aneurysms can especially sometimes present with left upper lobe mass suspicious for primary lung malignancy invading the aortic arch. Physicians should keep high index of suspicion when dealing with left upper lobe lesions. Reference #1: Che G, Chen J, Liu L, Zhou Q. Rupture of aorta arch aneurysm into the lung with formation of pseudoaneurysm. Interactive cardiovascular and thoracic surgery. 2006 Feb 1;5(1):55-7. DISCLOSURES: No relevant relationships by Mirza Ali, source=Web Response No relevant relationships by Phyo Kyaw, source=Web Response No relevant relationships by Faraaz Nayeemuddin, source=Web Response no disclosure on file for Rajagopal Sreedhar; No relevant relationships by Saad Ullah, source=Web Response" @default.
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• W2980866628 date "2019-10-01" @default.
• W2980866628 modified "2023-09-27" @default.
• W2980866628 title "LEFT UPPER LOBE OPACITY: A DIAGNOSTIC DILEMMA" @default.
• W2980866628 doi "https://doi.org/10.1016/j.chest.2019.08.1099" @default.
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