Presentations

Abstract

Introduction:

With the overall increase in medical imaging studies performed, Incidental findings on diagnostic workup for a condition are a well-known occurrence in the medical field. Rarely, however, does incidental workup reveal two, concurrent primary cancers. We report an interesting case of a patient who was admitted with stroke-like symptoms and was incidentally found to have two primary lung cancers.

Case Description:

A 66-year-old male with a 25-pack-year smoking history and past medical history of hypertension and hyperlipidemia presented to the Emergency Department with stroke-like symptoms. He was found to have an ischemic stroke which was managed appropriately. Incidentally, his chest X- ray revealed a suspicious, right middle-lobe pulmonary nodule. This finding prompted a CT chest which demonstrated a 4.1 cm, spiculated mass with multiple, sub-6 mm pulmonary nodules in the right middle and upper lobes. Subsequently, endobronchial ultrasound with Bronchoalveolar lavage (BAL), brushing, and transbronchial biopsy were performed. Bronchial brushing was positive for non-small cell carcinoma and BAL demonstrated atypical cells. Fluoroscopic-guided right middle lobe biopsy demonstrated adenocarcinoma and a small focus of carcinoid tumor. PET showed FDG avidity in the right middle lobe mass consistent with primary bronchogenic malignancy as well as avidity in a subcentimeter mediastinal lymph node. The patient is currently scheduled for another PET to determine the necessity of surgical resection in addition to chemotherapy.

Discussion:

Incidental findings on imaging may sometimes lead to inconsequential diagnostic workups; however, in this case, an incidental pulmonary nodule was discovered to be two primary pulmonary cancers. Although improved imaging techniques and cancer survivability are causing an increase in incidental findings, finding two synchronous pulmonary cancers remains a rare occurrence. Such a case demonstrates the importance of maintaining a high index of suspicion in the workup of incidental findings in relevant clinical contexts as they may allow prompt detection of malignancy and improve prognostic outcomes for patients.