An Unusual Mass

A 76-year-old male who was a current smoker had a chest X-ray performed for symptoms suggestive of a lower respiratory tract infection. He did not have any haemoptysis or weight loss.

Image from New Zealand Medical Journal.   Shoaib Faruqi, et al. (link)

The X-ray was appropriately reported as showing a large soft tissue mass in the right middle zone 10 centimetres in diameter with a smooth superior and lateral outline and ill-defined medial and inferior margins, projecting over the upper pole of the right hilum. A computed tomography scan and chest referral was subsequently suggested.
The radiological finding had a rather benign explanation. On inspection, over the anterior chest wall there was a large sub-cutaneous swelling consistent with that of a lipoma (figure below). This had been present for more than 20 years. It corresponded to the shadow on the chest X-ray. A lateral film confirmed that there was no parenchymal lung lesion and it was the lipoma which was the cause for the radiological shadow.
This case emphasises the importance of interpreting radiological findings in the appropriate clinical context. It also demonstrates the importance of a lateral film in delineating the anatomical position of a chest lesion.
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