roentgenogram of the month An Asymptomatic Hilar Mass· Gregor P. M . Mannes, M.D.; Eric] van der ]agt, M.D. , Ph.D .; and Pieter E. Postmus; M.D., Ph.D.
A 69-year-old, nonsmoking woman was admitted to the Department of Pulmonary Diseases because
(Chest 1992; 101:553-54)
of a mass seen on the lateral chest roentgenogram (Fig 1), which was hardly visible on the posteroanterior chest roentgenogram . Her medical history consisted of hypertension and several abdominal operations. She complained of a dry cough, lasting more than 25 years, without signs of allergy or bronchial hyperresponsiveness. The only medication she used was atenolol. Physical examination revealed no abnormalities, apart from obesity. Blood pressure was 180/100 mm Hg. Routine laboratory findings were normal. Spirometry showed a minimal expiratory airway obstruction, almost completely reversible with ipratropium bromide. The histamine threshold was normal. Electrocardiography showed a sinus rhythm with a normal QRS complex , and echocardiography revealed good function of the left ventricle and a normal mitral valve. There was no good view of the right heart. Radiographs of the esophagus and stomach were normal. At bronchoscopy no endobronchial tumor was seen. The orifice of the middle lobe was somewhat narrowed by ventral compression. Biopsies showed normal bronchial tissue . At bronchography of the right side, expiratory collapse of the entrance to the middle lobe was seen. Computed tomography showed a wellcircumscribed, somewhat lobulated tumor in the posterior right hilum, with enhancement after intravenous injection of contrast material (Fig 2). Pulmonary angiography was performed. *From the Departments of Pulmonarv Diseases (Drs Mannes and Postmus) and Diagnostic Radiology (Dr van der jagt), University Hospital. Groningen, The Netherlands.
FI
A 69-year-old, nonsmoking woman was admitted to the Department of Pulmonary Diseases because
(Chest 1992; 101:553-54)
of a mass seen on the lateral chest roentgenogram (Fig 1), which was hardly visible on the posteroanterior chest roentgenogram . Her medical history consisted of hypertension and several abdominal operations. She complained of a dry cough, lasting more than 25 years, without signs of allergy or bronchial hyperresponsiveness. The only medication she used was atenolol. Physical examination revealed no abnormalities, apart from obesity. Blood pressure was 180/100 mm Hg. Routine laboratory findings were normal. Spirometry showed a minimal expiratory airway obstruction, almost completely reversible with ipratropium bromide. The histamine threshold was normal. Electrocardiography showed a sinus rhythm with a normal QRS complex , and echocardiography revealed good function of the left ventricle and a normal mitral valve. There was no good view of the right heart. Radiographs of the esophagus and stomach were normal. At bronchoscopy no endobronchial tumor was seen. The orifice of the middle lobe was somewhat narrowed by ventral compression. Biopsies showed normal bronchial tissue . At bronchography of the right side, expiratory collapse of the entrance to the middle lobe was seen. Computed tomography showed a wellcircumscribed, somewhat lobulated tumor in the posterior right hilum, with enhancement after intravenous injection of contrast material (Fig 2). Pulmonary angiography was performed. *From the Departments of Pulmonarv Diseases (Drs Mannes and Postmus) and Diagnostic Radiology (Dr van der jagt), University Hospital. Groningen, The Netherlands.
FI
