CTICasesSmall Cell Carcinoma Mimicking Pneumonia
Imaging findings
A radiograph initially read as right upper lobe pneumonia during flu season shows, on closer review of the lateral view, a filled-in subcarinal space, absent right-sided airway margins with no visible intermediate stem line, and a large opacity projecting posteriorly that is too extensive to represent the left pulmonary artery alone; the frontal view shows subtle carinal splaying. A month later, after antibiotics failed, CT reveals an enormous small cell carcinoma nearly obliterating the bronchus intermedius and occluding the right superior pulmonary vein, extending into the right lower lobe.
Key takeaways
The original radiographic findings actually reflected a combination of venous and lymphatic obstruction from the underlying tumor rather than infection, and the lateral view was more revealing than the frontal view for this posterior mediastinal mass. This underscores the value of scrutinizing the retrocarinal and subcarinal regions and the lateral radiograph when a presumed pneumonia fails to respond to treatment.
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