CTICasesSquamous Cell Carcinoma of the Right Lower Lobe with Bilateral Airway Involvement
Imaging findings
In a 37-year-old patient initially diagnosed elsewhere with right lower lobe pneumonia, closer review of the mediastinum and airways reveals subtle narrowing of both the right and left mainstem bronchi in the subcarinal region; CT obtained after the patient developed hemoptysis shows marked bilateral bronchial narrowing from a central mass with splaying of adjacent vessels, extensive mediastinal lymphadenopathy, and post-obstructive pneumonia in the right lower lobe, with PET confirming the mass as the primary lesion.
Key takeaways
Despite an initial impression of carcinoid or lymphoma given the degree of lymphadenopathy, this proved to be a high-grade squamous cell carcinoma that had already metastasized, testing negative for HPV; the case is a reminder to always scrutinize the central airways and mediastinum in a patient with a presumed lobar pneumonia, since a subtle endobronchial or central mass causing post-obstructive pneumonia can otherwise be overlooked, even in an unusually young patient.
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