CTICasesNecrotic Adenocarcinoma Mimicking Lung Abscess
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Imaging findings
Initial CT chest reveals a cavitary lesion in the right lower lobe with associated airspace disease and a pleural effusion. Follow-up imaging demonstrates significant growth of the lesion, marked progression of wall thickness, and development of a nodular component within the walls. PET CT shows significant hypermetabolic activity in the lesion and positive lymph nodes in the subcarinal, hilar, and mediastinal regions.
Key takeaways
Necrotic adenocarcinomas can mimic lung abscesses on initial imaging, particularly with cavitary lesions and associated inflammation. Progressive growth, increasing wall thickness, and nodularity on follow-up, especially in a smoker, should raise suspicion for malignancy. PET CT can help differentiate inflammatory processes from hypermetabolic neoplastic lesions and detect metastatic lymphadenopathy.
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