Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 16, 2017; 5(4): 153-158
Published online Apr 16, 2017. doi: 10.12998/wjcc.v5.i4.153
Ominous lung cavity “Tambourine sign”
Ritu Verma, Ashu Seith Bhalla, Ankur Goyal, Deepali Jain, N Loganathan, Randeep Guleria
Ritu Verma, Ashu Seith Bhalla, Ankur Goyal, Department of Radiodiagnosis, AIIMS, New Delhi 110029, India
Deepali Jain, Department of Pathlology, AIIMS, New Delhi 110029, India
N Loganathan, Randeep Guleria, Department of Pulmonary Medicine and Sleep Disorders, AIIMS, New Delhi 10029, India
Author contributions: Verma R, Bhalla AS and Goyal A had contributed in imaging and radiological work-up; Loganathan N and Guleria R evaluated the patient clinically and provided treatment (chemotherapy); Jain D helped in making histopathological diagnosis; all authors have contributed in complete patient care.
Institutional review board statement: Isolated case reports are exempt from review and approval at our institution.
Informed consent statement: Verbal informed consent was taken at the time of conducting investigations that the case may be used in academic and teaching purpose maintaining identity and confidentiality of the patient.
Conflict-of-interest statement: Nil.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Ashu Seith Bhalla, Professor, Department of Radiodiagnosis, AIIMS, Old OT Block, New Delhi 10029, India.
Telephone: +91-011-26594925
Received: August 19, 2016
Peer-review started: August 22, 2016
First decision: November 14, 2016
Revised: November 28, 2016
Accepted: December 13, 2016
Article in press: December 14, 2016
Published online: April 16, 2017

Mucinous adenocarcinoma represents a rare subtype of adenocarcinoma of the lung, which is frequently invasive and has a poorer prognosis. Of its wide range of imaging appearances, air-space consolidation is the most frequent pattern while cavitary form has only rarely been reported. Despite imaging advancements, the differentiation of benign and malignant cavitary lung lesions sometimes remains imperfect. We propose “Tambourine” sign on computed tomography to raise the suspicion of mucinous adenocarcinoma in a lung cavity, under appropriate clinical settings. The sign indicates an irregular cavity with undistorted prominent thick walled bronchioles within the wall and draping along thereby resembling the musical instrument “tambourine”. Adjacent ground glass and internal septations may also be seen.

Keywords: Lung cavity, Tambourine, Adenocarcinoma mucinous, Tomography, X-ray

Core tip: Lung cavities are commonly encountered in routine chest imaging and diagnosis may become a challenge in certain cases despite advances in imaging techniques. Imaging points have been described in literature to differentiate benign from malignant cavities that help in diagnosing most of the cases, however some lesions are still difficult to interpret and accurately diagnose. Tambourine sign has been introduced by us for a relative thin walled lung cavity where undistorted smaller bronchi with thickened and prominent walls are seen to be entering and draping along the cavity walls. This imaging sign resembles the musical instrument tambourine, and this is ominous and point towards a more sinister lesion as in our case and in similar cases reported in literature. Hence in appropriate clinical and imaging background this sign should be carefully looked at and appropriate workup should be done for timely diagnosis.