Radiology Review

Man Presents with Altered Mental Status and Confusion

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A 59-year-old man presents to your facility for evaluation of altered mental status and confusion that have progressively worsened in the past two months. He denies any injury or trauma. He states he has had associated headaches and dizziness. He denies any weight loss, shortness of breath, or malaise; however, he himself is able to notice that his mentation has “not been right.” His medical history is significant for mild hypertension and hyperlipidemia, both of which are well controlled. He discloses a 50–pack-year history of cigarette use. Physical exam reveals a male in no obvious distress but complaining of a moderate headache. His vital signs are stable. His oxygen saturation is 97% on room air. Breath sounds appear clear. The neurologic exam shows no focal deficits. You order noncontrast CT of the head, as well as a chest radiograph. The chest radiograph is shown. What is your impression?


 

ANSWER
The chest radiograph demonstrates a fairly large right hilar mass with an associated right upper lobe infiltrate. This finding is very worrisome for a bronchogenic carcinoma.

Subsequent CT of the brain also demonstrated a right parietal mass. Thus, this lung lesion is most likely a primary neoplasm with metastatic involvement.

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