Hyperdense Endobronchial Mass - A Rare Manifestation of Metastatic Melanoma
A 57-year-old man with a history of right lower extremity cutaneous melanoma, who had undergone first and second toe amputation 3-years prior, presented with dyspnea and black-colored sputum. Chest radiograph revealed a collapsed left lung, pathologic fracture of the left sixth rib, and a destructive mass involving the right posterior fifth rib []. Non-Enhanced CT (NECT) of the chest showed a hyperdense mass with a mean density of 56 Hounsfield units within the left main bronchus, resulting in postobstructive left lower lobe collapse [Figure and ]. In addition, there were two hyperdense left lower lobe intraparenchymal masses, one of which was lobulated []. There were also lytic bone lesions in the right scapula (not shown) and thoracic vertebrae []. Contrast-enhanced CT (CECT) through the lower chest demonstrated heterogeneous enhancement of the left lower lobe masses []. Bronchoscopy revealed a black-colored hemorrhagic endobronchial mass that was confirmed on histopathology to be an endobronchial metastasis from melanoma []. The patient was treated with imatinib (Gleevec) (Novartis Pharmaceuticals, East Hanover, NJ, USA).