PMC4532105_01
Chest P-A shows blunting of right costophrenic angle, accentuation of pulmonary vascular markings, and slight enlargement of right superior mediastinum
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CEA and alpha feto protein were 6.42 ng/ml and 5 ng/ml, respectively. Chest P-A showed blunting of right costophrenic angle, accentuation of pulmonary vascular markings, and slight enlargement of right superior mediastinum (Fig. 1).
Perfusion lung scan shows multiple segmental perfusion defects in right lower lung.
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The perfusion lung scan showed multiple segmental perfusion defects in right lower lung (Fig. 2), but the ventilation lung scan showed no significant ventilation defect, suggestive of V/Q mismatch on right lower lung (Fig. 3).
Chest CT scan shows an irregular marginated non-enhancing low-density mass with pleural effusion in the left lower lung, and ipsilateral mediastinal lymph nodes enlargement. And round, small, lower-density was detected in SVC, suggestive of thrombosis of SVC.
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SVC was partially filled with a small, low-density mass, which was suggestive of a thrombus (Fig. 4).
Fine needle aspiration cytology shows a cluster of large atypical cells with prominent nucleoli on inflammatory background.
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Some of the cells disclosed phagocytoses of the neutrophils (Fig. 5).
Histologic findings of lymph node show sinusoidal infiltration of large cell carcinoma with many neutrophils
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Many neutrophils were infiltrated among the tumor cells (Fig. 6).
Echocardiogram shows severe pericardial effusion.
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EKG showed low voltage and electrical alterance on all leads and echocardiogram revealed severe pericardial effusion (Fig. 7).