This is an unusual case from Hospital Universitario Dr. Peset. Valencia. I would just like to know how you approach a case with findings above and below the diaphragm.
The patient is a 25-year-old woman. Smoker for 10 years. She complains of fever and chest pain. She also had some vague epigastric discomfort.
Solution:
This case was chosen by Dr. Edgar Lorente, Radiology resident at Hospital Universitario Dr. Peset.
Findings: Several nodules/masses in the right lung. They are well defined, hypodense and containing rough calcifications, some of them “Popcorn like”.
In the barium studies there are submucosal masses (arrow) in the gastric wall, and the CT shows these tumours with a density similar to that of muscle.
Therefore we have two main findings: pulmonary masses and gastric tumours.
(No extra adrenal lesions were present in this case.)
Diagnosis: Pulmonary chondromas and Gastric GIST = Carney’s triad
This disease is characterised by:
- Gastric GIST + pulmonary chondromas + extraadrenal paraganglioma
- Possibly genetic
- Young women
- Complete 1/5 of cases
- Majority 2 or 3 (Usually GIST + pulmonary chondromas)
The possible differential diagnosis of Lung masses/nodules with calcium and submucosal gastric tumours
Inflamatory pseudotumour of the lung and stomach
Pulmonary hamartomas-chondromas and GIST
Other causes of multiple lung masses/nodules with calcium:
Tuberculomas
Amyloid
Metastases from tumours with bone/calcium
