A TUMOR OF THE THORACIC CAVITY IS DETECTED BY AN ABDOMINAL ULTRASOUND

THE ULTRASOUND IMAGING SHOWED THAT SHE HAD AN ABNORMAL MASS IN THE BOTTOM OF HER RIGHT LUNG.. SO WITH THESE ULTRASOUND IMAGES, AND THE PATIENT WAS WITHOUT SYMPTOMS, I THOUGHT IT WAS HARD

A TUMOR OF THE

THORACIC CAVITY IS

DETECTED BY AN

ABDOMINAL

ULTRASOUND

TRAN THI BICH THUY, MD

RADIOLOGY DEPARTMENT MEDIC HO CHI MINH, VIETNAM

HISTORY OF THE PATIENT

• A 53-year-old female patient went to the ultrasound department for an annual routine check-up At that time, she only felt tired sometimes She likely

had no symptoms

THE ULTRASOUND IMAGING SHOWED THAT SHE HAD AN ABNORMAL MASS IN THE BOTTOM OF HER RIGHT LUNG WE COULD SEE IT BY THE ULTRASOUND SECTION THROUGH THE RIGHT LIVER AND THE DIAGRAM AT FIRST, IT WAS HARD TO HAVE THE RIGHT DIAGNOSIS BECAUSE WE WONDERED IF IT WAS A LIVER MIRROR ARTIFACT

IMAGE

VIDEO DIAMETER OF THE MASS ARE 55X35

MM

THEN WE TRIED TO USE OTHER SECTIONS, WITH THE ULTRASOUND SECTION THROUGH FROM HER BACK, THE MASS WAS STILL DETECTED SO THAT IS A REAL LESSON THE LESSON IS 53CM 35 CM IN DIAMETER, AND IT APPEARS DIFFERENT FROM THE LIVER IN TERMS OF DENSITY, IT HAD NO AIR BRONCHOGRAM IMAGE, AND THE DOPPLER MODE DID NOT SHOW ANY SIGNAL DOPPLER CLEARLY SO WITH

THESE ULTRASOUND IMAGES, AND THE PATIENT WAS WITHOUT SYMPTOMS, I THOUGHT IT WAS HARDLY A LUNG CONSOLIDATION, IT WAS MORE LIKELY A TUMOR

ULTRASOUND SECTION THROUGH

THE BACK OF THE PATIENT

THEN, IN THE COMPUTED TOMOGRAPHY IMAGING (CT SCAN),

IT IS LIKELY A TUMOR OF THE LUNG.

THE PATIENT WAS UNDERGOING SURGERY TO CUT THE TUMOR THE PATHOLOGY SHOWS IT IS A BENIGN TUMOR OF THE LUNG - PULMONARY

LEIOMYOMA.

LUNG ULTRASOUND SECTIONS

• An illustration showing the

technique of the lung and

intercostal upper abdomen

ultrasound examination

(arrows indicate directions of

probe application).

CASE REFERENCE 1 : LUNG ULTRASONOGRAMS OF LESIONS ON THE

PLEURAL DIAPHRAGMATIC SURFACE

• (2a) nodules on the right diaphragmatic

pleural surface and pleural effusions; (2b)

pleural nodules and pleural effusions on the

left side; and (2c) (2d) Bulky tumors on the

right diaphragmatic pleural (and abdominal)

surface and pleural effusions

Abbreviations: (*) diaphragm; (A) ascites;

(L) liver; (PE) pleural effusions; (S) spleen;

(T) tumor Comment: The diaphragm is

seen as a “bright line” and indicates the

reflection between the air-filled lung and

adjacent tissues A normal diaphragm is 3–

10 mm thick in the costal part and in the

crus, respectively

•

CASE REFERENCE 2 : INTERCOSTAL UPPER ABDOMEN ULTRASONOGRAMS OF LESIONS

ON THE ABDOMINAL DIAPHRAGMATIC

SURFACE

• : (3a) bulky tumors between the liver

and diaphragm; (3b) solid-cystic

tumors between the liver and

diaphragm; (3c) tumor on the spleen

surface; and (3d) plaque lesion on the

right posterior abdominal surface of

the diaphragm and pleural effusions.

Abbreviations: (*) diaphragm; (L) liver;

(PE) pleural effusions; (S) spleen; (T)

tumor.

•

CASE REFERENCE 3 : LUNG ULTRASONOGRAPHY AND CHEST COMPUTED TOMOGRAPHY (CT) OF THE LOWER PARTS OF

THE PLEURAL SPACE AND LUNGS

• (4a) ultrasound presentation of lung

consolidation, a sonographic air

bronchogram with inflammation, and a

metastatic parenchymal lung lesion

(arrow, FL), pleural effusions, and

diaphragm thickening; (4b) chest CT

presentation of lung consolidation in the

right and left lower lobes; and (4c) (4d)

enlarged cardiophrenic lymph nodes

(hyperechoic round lesions) on

ultrasonography (3c) and chest CT (4d)

Abbreviations: (CPLN) cardiophrenic

lymph nodes; (DT) diaphragm thickening;

(FL) focal lesion in the lung; (H) heart; (L)

liver; (LA) lung with atelectasis; (T) tumor

CASE REFERENCE 4 : TUMOR OF

THE PERIPHERAL OF THE LUNG

• Peripheral lung mass on the left side with

splenic and liver metastases.

• Vascularity within the mass is important to note.

CASE REFERENCE 5 :SONOGRAPHIC

APPEARANCE OF A CONSOLIDATED LUNG

• The echo-texture of the lung becomes

similar to the liver.

CASE REFERENCE 6 LIVER MIRROR

ARTIFACT

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IN CONCLUSION,

An ultrasound of the abdomen can detect the tumor at the

bottom of the lung We need some other ultrasound

sections such as a section from the patient's back to

differentiate whether it is a liver mirror artifact or it is a lung

consolidation or a tumor Some features such as the

Doppler signal, and air bronchogram image are helpful for

diagnosis.

REFERENCE