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

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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

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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

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VIDEO DIAMETER OF THE MASS ARE 55X35

MM

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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

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ULTRASOUND SECTION THROUGH THE BACK OF THE PATIENT

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THEN, IN THE COMPUTED TOMOGRAPHY IMAGING (CT SCAN), IT IS LIKELY A TUMOR OF THE LUNG.

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

LEIOMYOMA.

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LUNG ULTRASOUND SECTIONS

• An illustration showing the technique of the lung and intercostal upper abdomen ultrasound examination

(arrows indicate directions of probe application).

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CASE REFERENCE 1 : LUNG ULTRASONOGRAMS OF LESIONS ON THE

PLEURAL DIAPHRAGMATIC SURFACE

<b>• (2a) nodules on the right diaphragmaticpleural surface and pleural effusions; (2b)</b>

pleural nodules and pleural effusions on the

<b>left side; and (2c) (2d) Bulky tumors on the</b>

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.

•

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CASE REFERENCE 2:INTERCOSTAL UPPER ABDOMEN ULTRASONOGRAMS OF LESIONS ON THE ABDOMINAL DIAPHRAGMATIC

<b>• : (3a) bulky tumors between the liver</b>

anddiaphragm;<b>(3b)</b>solid-cystic tumorsbetweentheliverand

<b>diaphragm; (3c) tumor on the spleensurface; and (3d) plaque lesion on the</b>

right posterior abdominal surface of the diaphragm and pleural effusions. Abbreviations: (*) diaphragm; (L) liver; (PE) pleural effusions; (S) spleen; (T) tumor.

•

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

<b>• (4a) ultrasound presentation of lung </b>

consolidation, a sonographic air

bronchogram with inflammation, and a metastatic parenchymal lung lesion (arrow, FL), pleural effusions, and

<b>diaphragm thickening; (4b) chest CT </b>

presentation of lung consolidation in the

<b>right and left lower lobes; and (4c) (4d) </b>

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.

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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.

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CASE REFERENCE 5<b>:SONOGRAPHIC APPEARANCE OF A CONSOLIDATED LUNG</b>

•The echo-texture of the lung becomes similar to the liver.

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CASE REFERENCE 6 LIVER MIRROR

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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.

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REFERENCE

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