Mahfooz Akhtar  ( Atomic Energy Medical Centre, Nishtar Medical College and Hospital, Multan, Pakistan. )
Durr-e-Sabih  ( Atomic Energy Medical Centre, Nishtar Medical College and Hospital, Multan, Pakistan. )

Ultrasound is extensively used in our Centre to image abdominal viscera and cardiac struc­tures. We also use sonography to visualize pleural lesions¹. This report describes the unusual ap­pearance of an epidermoid carcinoma of the lung as seen on sonography.

A 60 years old male presented with chest pain localized to the right upper chest. On inves­tigations, his ESR was 100 mm, leucocyte count of 18500/mm³ with a polymorphonuclear cell count of 85%. An X-ray chest showed a well defined lesion in upper and mid zone of the right lung (Figure 1).

Lung scan showed reduced perfusion of the same region. Ultrasound showed a rounded, well defined relatively an-echoic mass in the upper chest with posterior enhancement. No debris, septae or echogenic areas were seen in this ‘cystic’ structure (Figure 2).

The abdominal structures were normal. Casoni test was positive. The con­currence of imaging and serological results prom­pted a diagnosis of hydatid cyst of the lung and the patient was put on Albendazole. On follow-up, the patient’s clinical condi­tion had worsened with more pain, weakness and dyspnoea, he also reported an episode of hae­metemesis. An X-ray showed an increase in the size of the mass. Bronchoscopy revealed a malig­nant mass in the right upper lung. Thoracotomy showed this mass to be adherent to the parietal pleura. A right upper lobectomy was done. His­topathology study reported an epidermoid car­cinoma with adenomatous metaplasia.

Ultrasonography is generally not useful in the diagnosis of lung diseases but, in our ex­perience, peripherally located lesions can, at times, be seen and differentiation of solid from cystic lesions is possible in some cases. We have been successful in visualizing hydatid cysts of the lung, pneumonic consolidation and secondaries. Our failure to detect the consistency in this case might be because of the hypovascularity of the mass², or the homogeneity of the lesion³. This obviously needs to be examined with more patients and, if a pattern emerges, ultrasound might be­come an accessory investigation where modalities like CT and bronchoscopy are not available.

1. O\'Moore, P.V., Mueller, P.R., Simeone, J.F., Saini, S., Butch, RJ., Hahn, P.F., Steimer, E., Stark, D.D. and Ferrucei,J.T. Jr. Sonographic guidance in diagnostic and therapeutic intervention in the pleural space. MR., 1987;149:1.
2. Coleman, B.G., Anger, PH., Mulhern, C.B. Jr., Pollack, N.M., Banner, M.P. and Arenson, R.L. Gray-Scale sono­graphic spectrum of hypernephromas. Radiology, 1980;137:757.
3. Shirkoda, A., Staab, E.V. and Mittelstaedt, C.A. Renal lymphomas imaged by ultrasound and gallium-67. Radio­logy, 1980; 137(1 Pt.1):175.