CTICasesSubtle Left Hilar Lung Cancer (Squamous Cell Carcinoma)
Imaging findings
Chest radiograph shows a very subtle abnormality in the left hilum, described as an "absence of a normal structure" or a "little extra fullness" below the hilum, and an ill-defined opacity underneath the left bronchus. This was difficult to perceive, even retrospectively. CT, performed three weeks later, revealed a large left hilar mass, confirmed as squamous cell carcinoma, that was obstructing and distorting the left mainstem and upper lobe bronchi. The mass was significantly larger than suggested by the subtle initial radiographic findings.
Key takeaways
Hilar lung cancers can be exceptionally subtle on plain radiographs, manifesting as ill-defined fullness, loss of normal hilar contours, or absence of expected hilar structures. Even large masses can be overlooked. Careful attention to hilar symmetry and subtle changes is critical, especially in patients with symptoms, prompting further investigation with CT.
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