Clinical presentation
65 year old lady with generalized weakness since 3-4 months, persistent cough and breathing difficulty.
CT
Findings
A well defined heterogeneously enhancing intraparenchymal mass lesion is seen involving the anterior segment of left upper lobe with associated segmental bronchial cut off and secondary collapse. secondary reduced volume of left lung with multiple parenchymal nodules of varying sizes seen in both lung fields distributed in a bronchovascular pattern in an apicobasal gradient. Mild pericardial effusion and minimal left pleural effusion. Some of the scattered nodules are confluent. Couple of subcentimetric enhancing right lower paratracheal and aortopulmonary lymph nodes seen. No focal bone, adrenal or liver lesion.
Discussion
The bronchial cut off sign is an abrupt termination of bronchial lumen due to either a mass lesion, foreign body or mucus. Clearly the mass is responsible in this case and the presence of numerous intrapulmonary nodules favor a primary left upper lobe neoplasm with numerous intrapulmonary secondaries.