Pulmonary Manifestations of Systemic Disease: Fellow Case Report Poster - Pulmonary Manifestations of Lung Disease |

Extension of Pericardial Sleeve Into Lung Presenting as Lung Mass FREE TO VIEW

Sandeep Chennadi, MD; Hassan Patail, MD; Sikander Zulqarnain, MD
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SUNY Downstate, Brooklyn, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1049A. doi:10.1016/j.chest.2016.08.1156
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SESSION TITLE: Fellow Case Report Poster - Pulmonary Manifestations of Lung Disease

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: We report a unique case of fluid accumulation in pericardial recess, extending into right lung encasing the right inferior pulmonary artery, mimicking a lung mass in a patient with Systemic Lupus Erythematous (SLE).

CASE PRESENTATION: 71 year old lady with known SLE presented with productive cough,dyspnea and 10 pounds unintentional weight loss. Her examination showed oxygen saturation of 92% on room air, bibasilar fine crackles, loud P2 and trace bipedal edema. CT chest showed right hilar lesion measuring 6.4 x 3.4 cm encasing right pulmonary vasculature with resulting post-obstructive pneumonia. CT also showed bibasilar bronchiectasis, cystic changes and septal thickening suggestive of SLE associated ILD. Echocardiogram showed estimated Pulmonary Artery Systolic Pressure of 100mm Hg and moderate pericardial effusion. CT angiogram ruled out pulmonary embolism. CT angiogram further delineated right pulmonary artery from the mass. Interestingly, 3-D reconstruction showed extension of pericardial fluid into right pulmonic recess of transverse pericardial sinus encasing the right pulmonary artery all the way to right inferior pulmonary artery. Attenuation values were noted to be 20 Hounsfield Units (HU) in the perivascular space and 18 HU in pericardial effusion, both confirming fluid consistency. Patient was started on oral steroids and subsequent imaging showed near resolution of pericardial effusion and hilar lesion.

DISCUSSION: The transverse pericardial sinus divides into superior and inferior aortic recesses and right and left pulmonic recesses. Pericardial fluid in the recesses of transverse sinus mimicking lung tumor has not been described in literature. Fluid attenuation and contiguity with other pericardial spaces on multiplanar CT reformation are features that can be used non-invasively to differentiate pericardial recess from adenopathy or lung tumor.

CONCLUSIONS: Fluid in pericardial recesses can be misinterpreted as lung tumor or lymph node. This is the first reported case of fluid accumulation in pericardial recess and peri-vascular sleeve presenting as mass on non-contrast CT. Proper diagnosis and treatment can prevent unnecessary invasive procedures.

Reference #1: Kamen et al. Pulmonary manifestations of systemic lupus erythematosus. Clin Chest Med. 2010 Sep; 31(3):479-88.

Reference #2: Shroff GS et al. Differentiating pericardial recesses from mediastinal adenopathy: potential pitfalls in oncological imaging. Clin Radiol. 2014 Mar; 69(3):307-14.

DISCLOSURE: The following authors have nothing to disclose: Sandeep Chennadi, Hassan Patail, Sikander Zulqarnain

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