대한흉부영상의학회 Weekly Chest Cases

Case No : 240 Date 2002-06-01

Courtesy of Nae-Jin Han, M.D., Joon Beom Seo, M.D., Koun-Sik S / Asan Medical Center, Seoul, Korea
Age/Sex 41 / M
Chief ComplaintMass on chest radiograph, no specific symptom

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Diagnosis With Brief Discussion

Diagnosis: Lung Cancer associated with Bullae
Radiologic Findings: Chest radiograph shows radiolucent area representing bulla in both upper lobes and mass adjacent in right upper lobe. CT scan shows well-demarcated mass in contact with the bulla in subpleural portion of right upper lobe.

Right upper lobectomy was done and pathologic diagnosis was poorly differentiated adenocarcinoma. On gross pathologic findings, firm mass is presented in the subpleural area adjacent to bulla.
Brief Review: Lung cancer may develop in case of bullous disease such as emphysematous giant bulla, lung cyst, and pneumothorax. The frequency of lung cancer-associated bullous emphysema has been estimated at 2-6% (1). The majority of lung cancer associated with bullous disease is non small-cell tumors. In Japanese literature, three major patterns of lung cancer associated with large bulla was proposed: nodular opacity within or adjacent to the bulla, partial or diffuse thickening of the bulla wall, and secondary sign of the bulla (changed diameter, fluid retention, and pneumothorax) (2). Any lung mass associated with bulla should be considered an indication for surgery.
References: 1. Watts MA, Klayton RJ, Munzel TL. Bullous emphysema and carcinoma of the lung: Case report. Mil Med 1982;147:320-323.
2. Tsutsui M. Araki Y. Shirakusa T. Inutsuka S. Characteristic radiographic features of pulmonary carcinoma associated with large bulla. Annals of Thoracic Surgery. 1998;46(6):679-83.
Keywords: Lung, Malignant tumor,

No. of Applicants : 16

▶ Correct Answer : 7/16, 43.8%

- Choong-ju Hospital Konkuk University, Korea Chang Hee Lee
- Dong-Ulsan Imaging Clinic, Korea Hoon-Hwa Kim
- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- IMSL, Metz, France Eric Gaconnet
- Sint Andriesziekenhuis Tielt, Belgium Liong DJOA
- Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate
- Taipei Municipal Jen-Ai Hospital, Taiwan Hui-Ju Tsai

▶ Semi-Correct Answer : 5/16, 31.3%

- Catholic Medical Center, Korea Hyun Jin Park
- Gwangmoung Seongae Hospital, Korea Jiyong Rhee
- Gwangmoung Seongae Hospital, Korea Jeong Soo Jeong
- Ospedale di Jesi, Italy Giancarlo Passarini
- Sungji Hospital, Korea Jung Hee Kim

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 240 Date 2002-06-01

Discussion

No. of Applicants : 16