A case of hilar and mediastinal lymph nodes metastases from unknown primary site which is difficult to diagnose for pulmonary abscess and pulmonary infarction

Abstract

A 61-year-old woman was admitted to our hospital with pneumonia on chest X-ray. Chest CT demonstrated a pulmonary abscess with cavity in the lt. S⁶. Furthermore, a mass shadow in the lt. S¹⁰, and hilar lymph nodes adenopathy were also indicated. TBLB and lung biopsy under CT guidance were performed, however diagnosis was not confirmed. After treatment of the pulmonary abscess, the patient underwent surgery. During the operation, a mass in the lt. S¹⁰, and Botallo's and subcarinal lymp nodes were sampled for diagnosis. Frozen section examination indicated pulmonary infarction for the mass in lt. S¹⁰, poorly differentiated carcinoma for Botallo's lymph node and moderately differentiated adenocarcinoma for the subcarinal lymph node. The patient underwent concurrent chemoradiotherapy and is well after surgery. This case was difficult to diagnose as hilar and mediastinal lymph node metastases from an unknown primary site, with the cause of pulmonary abscess and pulmonary infarction.