CTICasesAdenocarcinoma of the Lung with Adrenal Metastasis
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Imaging findings
A 49-year-old presented with microscopic hematuria and weight loss. A CT urogram revealed a low-attenuation, enhancing mass in the right adrenal gland, with suspected invasion into the liver. A chest radiograph six days later showed complete consolidation and collapse of the right upper lobe with significant volume loss, thickening of the posterior wall of the bronchus intermedius, and narrowing of the left main bronchus. An extra opacity was noted over the aorta. Subsequent CT confirmed a massive lung tumor, ultimately diagnosed as metastatic adenocarcinoma of lung primary.
Key takeaways
This case highlights an unusual presentation of lung adenocarcinoma, where symptoms from an adrenal metastasis (hematuria) preceded significant respiratory symptoms despite extensive primary lung involvement. It underscores the importance of considering distant metastases in the evaluation of unexplained masses and maintaining a broad differential even when focused on one anatomical region, reminding radiologists to 'think about what's going on in the abdomen' when looking at a chest CT and vice versa.
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