Localised right upper-lobe pulmonary oedema caused by extension of giant cell carcinoma to the mitral valve

Abstract

ABSTRACT. Giant cell carcinoma of the lung is a very rare primary malignant tumour and localised right upper-lobe pulmonary oedema is also unusual. We report a case of giant cell carcinoma, which invaded the left atrium through the left pulmonary vein and caused localised right upper-lobe pulmonary oedema. Giant cell carcinoma of the lung is a very rare primary malignancy associated with highly aggressive clinical behaviour and poor prognosis. To our knowledge very few CT images of patients with pulmonary giant cell carcinoma have been reported. Furthermore, localised right upper-lobe pulmonary oedema is also unusual. The case presented here exhibited clinical, radiographic and pathophysiological features of right upper-lobe pulmonary oedema. We report a case of localised right upperlobe pulmonary oedema caused by extension of giant cell carcinoma to the mitral valve. Case reportA 54-year-old man presented with an increasing cough and haemoptysis for 2 weeks. His past medical history included prior myocardial infarction and he underwent coronary artery bypass graft surgery 7 years ago. He had no history of pleuropulmonary disease. He was an alcoholic with a daily consumption of alcohol of more than 80 g during the past 10 years and had smoked for more than 10 pack-years (1 pack-year is an average of 1 pack of cigarettes smoked per day for a year).A chest radiograph showed complete opacification of the left hemithorax and elevation of the left diaphragm (not shown). Contrast chest thin-section CT images showed an ill-defined huge mass with extensive necrosis in the left lower lobe and multiple mediastinal and hilar lymph node enlargement (not shown). The left main bronchus was obstructed by a tumour with resultant left lung atelectasis. Moreover, the tumour had invaded the left atrium through the left pulmonary vein. Histopathological examination of a transbronchial biopsy showed non-small cell carcinoma (not shown).Although chemotherapy was administered to the patient, the tumour grew rapidly. A chest radiograph, which was obtained 1 month after the initial chest radiograph, revealed airspace shadowing confined to the right upper lung field (Figure 1). Contrast-enhanced thin-section CT images showed that the masses in the left lung, the left main bronchus and the left inferior pulmonary vein had increased in size (not shown). In addition, the tumour in the left atrium had also grown and the mitral valve dilated with invasion into the left ventricle (Figure 2). The CT images showed localised consolidation with air bronchogram in the right upper lobe, which was thought to be localised pulmonary oedema caused by mitral valve regurgitation owing to tumour progression to the left ventricle (Figure 3). In addition, metastatic right pulmonary small nodules and bilateral adrenal masses were observed on CT images (not shown).One week later the patient died of massive haemoptysis. The autopsy revealed that the left huge mass had invaded the left pulmonary vein, the left atrium and the left ventricle, and caused mitral val...