PMC4857329_01
Portable CXR done on the day of admission shows moderate left pleural effusion and left basilar atelectasis.
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Following evaluation in the ER, she was found to have recurrence of large left-sided pleural effusion on CXR (Figure 1), so she was admitted on the floor for further evaluation and treatment.
CT scan of chest with contrast showing large left pleural effusion with associated areas of airspace opacity related to consolidation and/or atelectasis. Fluid at the left cardiophrenic sulcus appears to be loculated. Mediastinal and hilar lymph nodes are enlarged. Also note malrotation of heart with the left ventricular apex directed laterally rather than anteriorly, possibly due to mass effect.
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Computed tomography (CT) scan of chest with contrast showed large partly loculated left pleural effusion increasing in volume as compared to previous CT chest done 1 month ago (Figure 2). Diffuse ground-glass opacities and non-specific mediastinal and hilar lymphadenopathy were also seen (Figure 2).
Large left pleural effusion with compressive left lower lobe atelectasis. Chest tube is in place.
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During the course of hospital stay, patient developed worsening atelectasis of left lung with large hemothorax (Figure 3).
H&E staining of lung biopsy specimen showing myxoid background, poorly differentiated cells and high mitotic figures.
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Pathology results confirmed the diagnosis of high-grade myxoid lung sarcoma (Figure 4).
Large heterogeneous enhancing mass arising in the left lower lobe with metastatic nodular pleural thickening along the left hemidiaphragm, left hemithorax and left major fissure, new since the previous examination. There is progressive mediastinal shift and mass effect upon the heart and trace pericardial effusion.
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Repeat CT chest was done which showed progressive mediastinal shift to the right and interval development of nodular hypertrophy or pleural thickening along the left major fissure, suggesting progression of malignant disease (Figure 5). There was also mass effect on heart and trace pericardial effusion (Figure 5).