CTICasesEndovascular Small Cell Lung Cancer Mimicking an Infectious/Inflammatory Nodule
Imaging findings
An initial outside CT angiogram obtained for chest pain incidentally showed a small branching nodular structure along a bronchovascular bundle in the middle lobe without an air bronchogram, interpreted as possibly infectious or inflammatory, with surveillance recommended. On six-month follow-up the lesion had enlarged with surrounding nodularity and branching structures suggesting an obstructed airway, raising concern for infection (including non-tuberculous mycobacteria); four months later it had grown into a large mass with new subcarinal, right hilar, and paratracheal lymphadenopathy, a non-acute pericardial effusion, and dilated tortuous vessels with visible side branches feeding into it, and biopsy revealed small cell lung cancer with retrospectively appreciated endovascular growth along a pulmonary vessel.
Key takeaways
Small cell lung cancer typically presents as a central mediastinal mass, but this case illustrates an unusual peripheral, slowly growing presentation that began as an endovascular or perivascular nodule and was initially indistinguishable from an infectious or inflammatory process on imaging; retrospective review showed subtle vessel dilation and shagginess around the lesion on the earliest study, and progressive violation of adjacent veins with abnormal visible side branches on serial imaging should raise suspicion for endovascular tumor invasion rather than a purely infectious etiology.
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