PMC5671702_01
(a) CXR on admission showing bilateral small pleural effusions and infiltrates. (b) CXR 48 hours after diuresis showing resolving infiltrates.
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fig1
Chest-roentgenogram (CXR) on admission showed bilateral pleural effusion and infiltrates which rapidly improved suggesting a diagnosis of heart failure rather than pneumonic process (Figure 1).
Chest CT with contrast ((a) and (b)): lung window (a) showing right upper lobe 15 mm lung nodule (red arrow), pulmonary congestion, and pleural effusion. (b) Mediastinal window showing same. (c) Mediastinal window showing hypodense right paratracheal lymph node of 3.1 cm with (red arrow).
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fig2
A chest computed tomography (CT) revealed a 15 mm spiculated nodule in the right upper lobe, a 10 mm nodule in the left upper lobe, chronic interstitial fibrosis, and a right paratracheal lymph node measuring 3.1 cm, unchanged from a prior chest CT performed three months prior (Figure 2).
(a) EBUS needle gauge 19 inside lymph node (red arrow); no clear coagulation necrosis identified in the image. (b) Aspirated fluid.
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fig3
Twenty ml of purulent appearing fluid was aspirated from the right paratracheal lymph node (Figure 3).
Lymph node pathology. Squamous cell carcinoma comprised sheets of malignant cells showing nuclear pleomorphism and nuclei (low magnification x100).
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fig4
The EB of right upper lobe endobronchial lesion and the core biopsy of material aspirated from 4R lymph node were consistent with squamous cell carcinoma (Figure 4).