Thorax 68:394-395 doi:10.1136/thoraxjnl-2012-201868
  • Chest clinic
  • Pulmonary puzzle

A rapidly growing lung mass with air crescent formation

  1. Elisabetta A Renzoni1
  1. 1Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
  2. 2Department of Thoracic Surgery, Royal Brompton Hospital, London, UK
  3. 3Department of Respiratory Medicine, Western Sussex Hospitals NHS Trust, Worthing, UK
  4. 4Department of Histopathology, Royal Brompton Hospital, London, UK
  5. 5Department of Radiology, Royal Brompton Hospital, London, UK
  1. Correspondence to Dr Harpreet K Lota, Interstitial Lung Disease Unit, Royal Brompton Hospital, London, SW3 6NP, h.lota{at}

Pulmonary puzzle

A 58-year-old man who never smoked and was under follow-up for polymyositis associated with fibrotic interstitial lung disease was found to have an incidental opacity in the right upper lobe on a chest radiograph. He had been treated with daily azathioprine 200 mg and prednisolone 10 mg for 15 years. A CT chest revealed a mass-like lesion of relatively low attenuation suggesting necrosis (figure 1). Bronchoalveolar lavage was negative for microbiology and cytology. CT-guided biopsies were reported as showing necrosis and inflammation only. A month later, he developed cough with malodorous sputum, generalised fatigue, mild fevers, sweats and dyspnoea.

Figure 1

Initial CT through the upper lobes showing an amorphous relatively low attenuation (near-fluid density) mass in the posterior segment of the right upper lobe. Sections through …

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