Do not miss any of the new cases! Subscribe above to receive our newsletter! ↑↑

Do not miss the opportunity to download our app on the Google Play Store. Click here to enjoy it.

Previous

Case 352

Next


Click on the images above to zoom in

A 70-year-old male patient with systemic arterial hypertension and chronic obstructive pulmonary disease, followed by pulmonary emphysema. Former smoker (40 years.pack of cigaretts). Two months ago, noticed worsening cough and dyspnea on his usual efforts. In a return consultation, a simple chest X-ray was requested. After three months of symptoms worsening, a chest computed tomography (CT) was requested.

Considering the clinical history and the imaging tests presented, what is the most likely diagnosis?

a) Pulmonary hamartoma

25%

b) Malignant neoplasm of the lung

25%

c) Bronchogenic cyst

25%

d) Pulmonary sarcoidosis

25%
   

Image analysis

Image 1: Simple chest X-ray, posteroanterior (PA) incidence, orthostatic position. Nodular opacity of irregular contours projecting into the upper right lung lobe (red circle). Parenchymal bands at the pulmonary bases, compatible with lamellar subssegmental atelectasis (blue arrows). Stretching of the descending portion of the aorta (yellow arrow). Bilateral pleuropericardial adipose cushion (green arrows).

 

Image 2: Chest CT scan, coronal reconstruction, carinal level, lung window, after intravenous injection of iodinated contrast. Node with spiculated contours and pleural moorings located on the lateral border of the upper right lung lobe (red circle). Areas of panlobular (black arrows) and parasseptal (yellow arrows) emphysema. Lamellar subssegmentar atelectasis in the middle pulmonary lobe (blue arrow).

 

Image 3: Chest CT scan, axial cut, supracarinal level, mediastinum window, after intravenous injection of iodinated contras. Soft tissue attenuation nodule with spiculated contours, located at the lateral border of the posterior segment of the right upper lobe lobe (red circle). Lymph node metastasis in the right inferior paratracheal mediastinal site, measuring 12 mm on its short axis (yellow arrow). Atheromatous calcification in the emergence of the brachiocephalic trunk (blue arrow).

 

Image 4: Chest CT, axial cut, infracarinal level, lung window, after intravenous injection of iodinated contrast. Spiculated contour, located on the lateral border of the posterior segment of the right upper lobe (red circle), measuring 2.4 cm x 2.0 cm. Areas of bilateral parasseptal emphysema (blue arrows), with lamellar subsegmentar atelectasis of permeation (black arrow). 

Highlights

          - Lung carcinoma is the main cause of death due to carcinoma, in both men and women, and smoking (currently or in the past) is the main risk factor for its onset; 

          - Patients with risk factors and with the onset or changing of the pattern of respiratory symptoms should be suspected and traced;

          - The appropriate imaging method for initial evaluation is simple chest x-ray, in the AP and lateral incidences ;

          - The presence of malignancy characteristics to the simple radiography or computed tomography will guide the continuation of the propaedeutics;

          - Pulmonary carcinoma presents asymptomatically in up to 50% of the cases, being an incidental finding in imaging tests.

References

-MacMahon H, Naidich DP, Goo JM, et al. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology 2017; 284: 228.

- National Lung Screening Trial Research Team , Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011; 365: 395-409. 10,1056 / NEJMoa1102873

-Wender R, Fontham ETH, Barrera E, et al. American Cancer Society Lung Cancer Screening Guidelines, 2013. Ca: A cancer journal for clinicians, 2013.

-Thomas KW, Gould MK. Overview of the initial evaluation, diagnosis, and staging of patients with suspected lung cancer. UpToDate, 2018.

-Stark, Paul. Imaging of lung cancer. UpToDate, 2018

-Herring, William. Learning radiology, recognizing the basics. 3 edition. Elsevier, 2016.

- Abdrabou, A. (2018). Pulmonary hamartoma | Radiology Case | Radiopaedia.org. [online] Radiopaedia.org. Available at: https://radiopaedia.org/cases/pulmonary-hamartoma-6 [Accessed 9 Aug. 2018]. - Silva CIS, Müller NL, et al.  Thorax - Brazilian College of Radiology and Diagnostic Imaging Series. 2nd Edition. Rio de Janeiro: Elsevier, 2017.

Authors

Izabella Costa Neves Silva, 5th year medical student at Universidade Federal de Minas Gerais.

E-mail: izabellacosta15 [at] hotmail.com

 

Supervisors

Weverton Cesar Siqueira, residency preceptor of Internal Medicine at Hospital das Clínicas of UFMG and Military Police Hospital of Belo Horizonte (HPM).

E-mail: weverton.csiqueira [at] gmail.com

José Nelson Mendes Vieira, radiologist and professor of the Department of Anatomy and Image of the University of Medicine of UFMG.

E-mail: zenelson.vieira [at] gmail.com

Reviewers

Prof. Viviane Santuari Parisotto Marino, Gabriel Santos, Gabriella Shiomatsu, Elaine Iwayama, Rafael Valério

Translated by

Luana Fonseca de Almeida, 4th year medical student at Universidade Federal de Minas Gerais.

E-mail: luana.fonseca.almeida[at]gmail.com

Test question

a)

25%

b)

25%

c)

25%

d)

25%

e)

25%
   

Commentics

Sorry, there is a database connection problem.

Please check back again shortly.

Bookmark and Share




Unfortunately there is no english translation available yet for this case.

Please refer to the Portuguese version instead or come back later.





Follow us:      Twitter  |    Facebook  |    Get the news  |    E-mail