PMC3949550_01
A - Chest radiograph frontal view: A large left upper lobe opacity obliterating the left heart border with luftsichel sign (black arrow). B - Chest radiograph lateral view: Major fissure is pulled anteriorly (white arrow) with hyperinflated left lower lobe (black arrow).
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Chest radiograph (CXR) (Fig. 1A) demonstrates luftsichel sign, which signifies left upper lobe collapse with an area of lucency around the aortic arch created by the hyperinflated left lower lobe, a portion of which wraps around the medial side of the collapsed left upper lobe. Chest radiograph (Fig. 1B) showed major fissure pulled anteriorly with hyper-inflated left lower lobe. Computed
A - CT chest cross sectional view: Large heterogenous left upper lobe mass (white arrow) with endobronchial lesion (black arrow). B - CT chest cross sectional view: The mass is separated medially from the vessels by the mediastinal fat plane (arrow head), posteriorly outlined by the major fissure (white arrow) and contains dilated cystic spaces with branching pattern suggestive of dilated bronchus filled with mucus (black arrow).
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Tomography (CT) (Fig. 2A and B) of chest showed a large heterogenous mass with an endobronchial component and dilated cystic spaces.
A 2 cm large exophytic, sessile luminal mass with intact mucosa obstructing the left upper lobe bronchus and covered with thick purulent secretions.
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There was a large pinkish polypoidal mass obstructing the left upper lobe bronchus with thick purulent secretions (Fig. 3).
A - High power view: Multiple glandular structures lined by mucin producing goblet cells (black arrow) in the background of stroma (arrow head). B - High power view: Stroma mixed with intermediate and clear cells (black arrow).
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Endobronchial biopsy showed (Fig. 4A and B) malignant epithelial neoplasm infiltrating the fibrous hyaline stroma.