PMC8725212_01
Admission chest radiograph showing a right peri-hilar dense opacity suspicious for
tumor mass (outlined by the red dotted line) with surrounding subtle areas of lung
atelectasis.
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A chest radiograph showed a right peri-hilar mass-like dense opacity concerning for malignancy (Figure 1).
Admission electrocardiogram showing bradycardia, variable junctional and ectopic atrial
rhythms, ventricular bigeminy, QT prolongation, low voltage, and short PR interval.
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Electrocardiogram (ECG) revealed bradycardia, variable junctional and ectopic atrial rhythms, ventricular bigeminy, QT prolongation, low voltage, T-wave abnormalities, and short PR interval (Figure 2).
Admission chest computed tomography (CT) showing a large cavitating necrotic mass in
the right middle lobe contiguous with the mediastinum, invading the superior vena cava
and right atrium with surrounding patchy lung consolidation. The tumor mass also encases
the bronchus intermedius and anterior segment bronchus of the right upper lobe.. Abbreviations: Ao, aorta; mPA, main pulmonary artery; LA, left atrium.. Yellow asterisk (bottom of superior vena cava and top of right atrium).
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Chest computed tomography (CT) revealed a large cavitating necrotic mass in the right middle lobe contiguous with the mediastinum, invading the superior vena cava and right atrium with surrounding patchy consolidation (Figure 3).
Echocardiogram showing (A) an extrinsic pericardial mass at the right atrial (RA) roof
and (B) right atrial mass measuring 5.0 x 4.4 cm.. Abbreviations: LV, left ventricle; RV, right ventricle.
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Echocardiogram showed an extrinsic pericardial mass at the right atrial roof (Figure 4A) with an atrial mass measuring 5.0 x 4.4 cm (Figure 4B).
Bronchoscopy showing mucosal erythema and extrinsic compression in the right bronchus
intermedius, with external compression of the right upper lobe bronchus.
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Bronchoscopy showed erythema and compression within the right bronchus intermedius and external compression of the right upper lobe bronchus (Figure 5).
Endobronchial biopsy revealing invasive well-differentiated squamous cell
carcinoma.
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Endobronchial biopsy revealed invasive well-differentiated squamous cell carcinoma and a clinical picture consistent with stage IIIB disease (Figure 6).
Electrocardiographic rhythm strips showing (A) right atrial enlargement (red arrows)
and (B) atrial flutter with variable (2:1) block with 2 premature ventricular complexes
(PVC) denoted by red asterisks. (Note: precordial lead with low voltages.)
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On hospital readmission 6 months later, the patient developed atrial fibrillation and flutter (with frequent ventricular ectopy) and electrocardiographic evidence of right atrial enlargement (Figure 7A, 7B), a right pleural effusion, and hypoxemic respiratory failure.