48 yo woman with subacute progressive dyspnea and cough

Case and content by Lauren Brown, MD
Expert radiology interpretation by David Godwin, MD


OBJECTIVE

Differentiate metastatic disease to the lung from primary lung malignancy.


CASE

48 yo woman with history of Stage IIB cervical cancer, treated with cisplatin and radiation four years ago, presents with two months of progressive dyspnea and nonproductive cough, acutely worsened in the last week and now associated with pleuritic chest pain. She describes one month of drenching night sweats and unintentional weight loss.  She was lost to follow-up after treatment for cervical cancer but reports normal mammogram and chest x-ray two years prior. She has a 50 pack-year smoking history.

CXR

Is this more likely to represent metastatic disease or primary lung malignancy?


DIAGNOSIS AND OUTCOME

TAKE HOME POINTS