Isolated mediastinal masses are an uncommon manifestation of prostate cancer metastasis. Here we report a unique presentation of a patient with prostate adenocarcinoma who presented with massive mediastinal adenopathy with aggressive tracheal invasion. CASE PRESENTATION:A 73 year old male with a history of prostate cancer was transferred for progressive dyspnea and radiographic airway narrowing. On physical exam the patient was in mild distress with phonation. He had course lung sounds in the upper lobes, diminished in the lower lobes, without stridor or wheezing. A computed tomography of the chest revealed a bulky right paratracheal mass that laterally invaded of the right side of the trachea. This caused approximately 50% occlusion of the tracheal lumen. The mass measured 7.6 cm AP, 7.9 cm transverse and 7.8 cm craniocaudal. CT demonstrated no parenchymal abnormalities or pulmonary nodules. Given the isolated lymphadenopathy, it was thought that this presentation was related to a separate primary lung malignancy over a metastatic focus of disease. The patient subsequently underwent debulking via rigid bronchoscopy. Pathology confirmed a diagnosis of metastatic prostatic adenocarcinoma with high-grade neuroendocrine carcinoma features.

Pulmonary imaging findings in e-cigarette and vaping use associated lung injury (EVALI) and coronavirus disease 2019 (COVID-19) may be similar. One such pulmonary radiographic finding is ground glass opacities (GGOs). These GGOs present a wide differential that is narrowed down through diagnostic testing, deliberation of past medical history as well as medication use, and social history. This case presents GGOs observed in a COVID rule-out admission clinically correlated with EVALI.

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