Case of the Month April 2014, page 2

For a full-size image, please click Shortness of Breath 3 .



Fig.-3: Axial CT the upper lung zones demonstrates diffuse interlobular septal thickening and a spiculated, soft-tissue density, perivascular nodule within the left upper lobe.

For a full-size image, please click Shortness of Breath 4



Fig.-4: Axial CT through the hila demonstrating thickening of the central bronchovascular bundles.

For a full-size image, please click Shortness of Breath 5



Fig.-5: Axial CT through the lower lung zones demonstrates septal thickening as well as thickening of the secondary lobular bronchovascular bundles.  
Another soft-tissue-density mass is identified abutting the SVC.

For a full-size image, please click Shortness of Breath 6 .



Fig.-6: Coronal CT, anterior.  Multiple scattered, irregular, soft-tissue density nodules identified.

For a full-size image, please click Shortness of Breath 7



Fig.-7:  Coronal CT, Mid-axillary.  Bilateral hilar fullness is seen in addition to the diffuse septal thickening.

For a full-size image, please click Shortness of Breath 8



Fig.-8: Coronal CT, posterior.  The “polygonal arcade” septa thickening and preserved architecture is most dramatic on this image.




Fig.-9: Small section of lung demonstrating septal thickening with prominence of the central bronchovascular bundle, “Dot-in-box” appearance.

For a full-size image, please click Shortness of Breath 10




Fig.-10: Axial CT.  A small nodule effusion with irregularity of the pericardium is concerning for metastatic implantation with a malignant effusion.

For a full-size image, please click Shortness of Breath 11 .



Fig.-11: Axial CT through the level of the kidneys demonstrates gross cortical irregularity, heterogeneity, and irregular calcification throughout the left kidney.  The perirenal fascia is thickened and the mass may be penetrating into the posterior pararenal fascia.  Multiple large, ipsilateral, retroperitoneal lymph nodes are seen in the vicinity.


What is the diagnosis?


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