CTICasesPulmonary Vein Invasion by Stage 1A Lung Adenocarcinoma Leading to Mediastinal Recurrence
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Imaging findings
Initial CT scan for stage 1A lung adenocarcinoma shows the primary tumor with an abnormally dilated vein in close proximity, which appears larger than surrounding veins. Post-treatment, the patient developed recurrences in mediastinal lymph nodes (AP window, left hilum) and distant sites, but not at the primary treatment site.
Key takeaways
Pulmonary venous invasion by lung adenocarcinoma, even in early-stage (T1a) lesions, can be a significant prognostic factor and a pathway for regional and distant metastasis. Subtle signs of venous involvement, such as dilated or abnormal veins adjacent to the tumor, should be carefully evaluated as they may predispose to mediastinal or distant recurrence, even after successful local ablative therapy like SBRT. The extent of vascular invasion may influence treatment planning and follow-up strategies.
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