Spontaneous Cavitation and Progressive Accumulation of Air in a Metastatic Mediastinal Lymph Node.

Abstract

A 70-year-oldman presentedwith progressive dyspnea, cough, andmild hemoptysis. Chest X-ray showed multiple cavitary lesions, prompting a computed tomography (CT) scan. The latter showed areas of ground-glass attenuation around multiple cystic lung lesions (Figure 1A), enlarged and necrotic mediastinal lymph nodes (LN), and, strikingly, a small amount of air within a necrotic LN in station 4R (Figure 1B). Bronchoscopy with bronchoalveolar lavage, transbronchial lung biopsies, and endobronchial ultrasound–guided transbronchial needle aspiration were performed. The airway was normal. Both LN and lung tumor were consistent with an angiosarcoma, and infection was ruled out. Subsequent images (positron emission tomography–CT) obtained for staging purposes within 45 days of original CT findings showed progressive accumulation of air in a 4R LN (Figures 1C and 1D), with the patient being asymptomatic. Of note, this particular LN showed only necrosis and tumor cells by endobronchial ultrasound–guided transbronchial needle aspiration, and intranodal air was, in fact, Figure 1. (A) Ground-glass attenuation surrounding a cystic lung lesion (arrow). (B–D) Progressive accumulation of air in a metastatic right paratracheal lymph node (arrow).