|
|
| Line 1: |
Line 1: |
| __NOTOC__ | | __NOTOC__ |
| {{Pancoast tumor}} | | {{Pancoast tumor}} |
| {{CMG}}{{AE}}{{Mazia}} | | {{CMG}}; {{AE}}{{Mazia}} |
|
| |
|
| ==Overview== | | ==Overview== |
| Line 7: |
Line 7: |
|
| |
|
| ==Differential Diagnosis== | | ==Differential Diagnosis== |
| Pancoast tumor must be differentiated from other causes of [[mass]] located in the [[Apical|apical region]] of the [[chest]] which may present with [[pain]] in the [[Shoulder-joint|shoulder region]].The table below summarizes the findings that differentiate [[apical]] [[mass]] in the [[chest]] from the most common other [[conditions]] that cause [[hemoptysis]], [[cough]], [[dyspnea]], [[wheeze]], [[chest pain]], [[shoulder pain]], [[Weight loss|unexplained weight loss]], [[Loss of appetite|unexplained loss of appetite]], and [[fatigue]]<ref><nowiki>{{Small cell lung cancer [Internet]. BMJ Publishing Group Limited 2015 [updated 2014 Oct 29]. Available from: </nowiki>http://bestpractice.bmj.com/best-practice/monograph/1081/diagnosis/differential.html<nowiki>}}</nowiki></ref><ref name="pmid24455507">{{cite journal| author=Bhatt M, Kant S, Bhaskar R| title=Pulmonary tuberculosis as differential diagnosis of non-small cell lung cancer | journal=South Asian J Cancer | year= 2012 | volume= 1 | issue= 1 | pages= 36-42 | pmid=24455507 | doi=10.4103/2278-330X.96507 | pmc=PMC3876596 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24455507 }}</ref><ref name="pmid22242302">{{cite journal| author=Kamiya K, Yoshizu A, Misumi Y, Hida N, Okamoto H, Yoshida S| title=[Lung abscess which needed to be distinguished from lung cancer; report of a case]. | journal=Kyobu Geka | year= 2011 | volume= 64 | issue= 13 | pages= 1204-7 | pmid=22242302 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22242302 }} </ref><ref name="pmid24008649">{{cite journal| author=Matsuoka T, Uematsu H, Iwakiri S, Itoi K| title=[Chronic eosinophilic pneumonia presenting as a solitary nodule, suspicious of lung cancer;report of a case]. | journal=Kyobu Geka | year= 2013 | volume= 66 | issue= 10 | pages= 941-3 | pmid=24008649 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24008649 }} </ref><ref name="emedicine">{{cite web | last = Beeson | first = Michael S | title = Superior Vena Cava Syndrome | url=http://www.emedicine.com/emerg/topic561.htm | accessdate = 2008-03-24 }}</ref><ref name="wikibooks">Radiation Oncology/Palliation/SVC Syndrome. WikiBooks https://en.wikibooks.org/wiki/Radiation_Oncology/Palliation/SVC_Syndrome Accessed on January 13, 2016</ref><ref name="pmid18349457">{{cite journal |vauthors=Bruzzi JF, Komaki R, Walsh GL, Truong MT, Gladish GW, Munden RF, Erasmus JJ |title=Imaging of non-small cell lung cancer of the superior sulcus: part 1: anatomy, clinical manifestations, and management |journal=Radiographics |volume=28 |issue=2 |pages=551–60; quiz 620 |date= 2008 |pmid=18349457 |doi=10.1148/rg.282075709 |url=}}</ref><ref name="pmid24102007">{{cite journal |vauthors=Foroulis CN, Zarogoulidis P, Darwiche K, Katsikogiannis N, Machairiotis N, Karapantzos I, Tsakiridis K, Huang H, Zarogoulidis K |title=Superior sulcus (Pancoast) tumors: current evidence on diagnosis and radical treatment |journal=J Thorac Dis |volume=5 Suppl 4 |issue= |pages=S342–58 |date=September 2013 |pmid=24102007 |pmc=3791502 |doi=10.3978/j.issn.2072-1439.2013.04.08 |url=}}</ref><ref name="pmid27429965">{{cite journal |vauthors=Marulli G, Battistella L, Mammana M, Calabrese F, Rea F |title=Superior sulcus tumors (Pancoast tumors) |journal=Ann Transl Med |volume=4 |issue=12 |pages=239 |date=June 2016 |pmid=27429965 |pmc=4930518 |doi=10.21037/atm.2016.06.16 |url=}}</ref><ref>[http://www.mountsinai.org/Other/Diseases/Thoracic%20outlet%20syndrome Thoracic outlet syndrome] | | Pancoast tumor must be differentiated from other causes of [[mass]] located in the [[Apical|apical region]] of the [[chest]] which may present with [[pain]] in the [[Shoulder-joint|shoulder region]].The table below summarizes the findings that differentiate [[apical]] [[mass]] in the [[chest]] from the most common other [[conditions]] that cause [[hemoptysis]], [[cough]], [[dyspnea]], [[wheeze]], [[chest pain]], [[shoulder pain]], [[Weight loss|unexplained weight loss]], [[Loss of appetite|unexplained loss of appetite]], and [[fatigue]] |
| Mount Sinai Hospital, New York</ref><ref>Stepansky F, Hecht EM, Rivera R, Hirsh LE, Taouli B, Kaur M, Lee VS. Dynamic MR angiography of upper extremity vascular disease: pictorial review. Radiographics. 2008 Jan-Feb;28(1):e28. Epub 2007 Oct 29. PMID 17967936 </ref><ref name="radio">Superior Vena Cava Syndrome.Dr Amir Rezaee and Radswiki et al. Radiopedia http://radiopaedia.org/articles/superior-vena-cava-obstruction Accessed on January 13, 2016</ref>
| |
|
| |
|
| {| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
| |
|
| |
|
| | align="center" style="background:#f0f0f0;" |'''Condition/disease'''
| | === '''The following table summarizes the differentiation of various lung tumors based on histological and topographical features:<ref><nowiki>{{Small cell lung cancer [Internet]. BMJ Publishing Group Limited 2015 [updated 2014 Oct 29]. Available from: </nowiki>http://bestpractice.bmj.com/best-practice/monograph/1081/diagnosis/differential.html<nowiki>}}</nowiki></ref><ref name="pmid24455507">{{cite journal| author=Bhatt M, Kant S, Bhaskar R| title=Pulmonary tuberculosis as differential diagnosis of non-small cell lung cancer | journal=South Asian J Cancer | year= 2012 | volume= 1 | issue= 1 | pages= 36-42 | pmid=24455507 | doi=10.4103/2278-330X.96507 | pmc=PMC3876596 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24455507 }}</ref><ref name="pmid22242302">{{cite journal| author=Kamiya K, Yoshizu A, Misumi Y, Hida N, Okamoto H, Yoshida S| title=[Lung abscess which needed to be distinguished from lung cancer; report of a case]. | journal=Kyobu Geka | year= 2011 | volume= 64 | issue= 13 | pages= 1204-7 | pmid=22242302 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22242302 }} </ref><ref name="pmid24008649">{{cite journal| author=Matsuoka T, Uematsu H, Iwakiri S, Itoi K| title=[Chronic eosinophilic pneumonia presenting as a solitary nodule, suspicious of lung cancer;report of a case]. | journal=Kyobu Geka | year= 2013 | volume= 66 | issue= 10 | pages= 941-3 | pmid=24008649 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24008649 }} </ref><ref name="emedicine">{{cite web | last = Beeson | first = Michael S | title = Superior Vena Cava Syndrome | url=http://www.emedicine.com/emerg/topic561.htm | accessdate = 2008-03-24 }}</ref><ref name="wikibooks">Radiation Oncology/Palliation/SVC Syndrome. WikiBooks https://en.wikibooks.org/wiki/Radiation_Oncology/Palliation/SVC_Syndrome Accessed on January 13, 2016</ref><ref name="pmid18349457">{{cite journal |vauthors=Bruzzi JF, Komaki R, Walsh GL, Truong MT, Gladish GW, Munden RF, Erasmus JJ |title=Imaging of non-small cell lung cancer of the superior sulcus: part 1: anatomy, clinical manifestations, and management |journal=Radiographics |volume=28 |issue=2 |pages=551–60; quiz 620 |date= 2008 |pmid=18349457 |doi=10.1148/rg.282075709 |url=}}</ref><ref name="pmid24102007">{{cite journal |vauthors=Foroulis CN, Zarogoulidis P, Darwiche K, Katsikogiannis N, Machairiotis N, Karapantzos I, Tsakiridis K, Huang H, Zarogoulidis K |title=Superior sulcus (Pancoast) tumors: current evidence on diagnosis and radical treatment |journal=J Thorac Dis |volume=5 Suppl 4 |issue= |pages=S342–58 |date=September 2013 |pmid=24102007 |pmc=3791502 |doi=10.3978/j.issn.2072-1439.2013.04.08 |url=}}</ref><ref name="pmid27429965">{{cite journal |vauthors=Marulli G, Battistella L, Mammana M, Calabrese F, Rea F |title=Superior sulcus tumors (Pancoast tumors) |journal=Ann Transl Med |volume=4 |issue=12 |pages=239 |date=June 2016 |pmid=27429965 |pmc=4930518 |doi=10.21037/atm.2016.06.16 |url=}}</ref><ref>[http://www.mountsinai.org/Other/Diseases/Thoracic%20outlet%20syndrome Thoracic outlet syndrome] |
| | | Mount Sinai Hospital, New York</ref><ref>Stepansky F, Hecht EM, Rivera R, Hirsh LE, Taouli B, Kaur M, Lee VS. Dynamic MR angiography of upper extremity vascular disease: pictorial review. Radiographics. 2008 Jan-Feb;28(1):e28. Epub 2007 Oct 29. PMID 17967936 </ref><ref name="radio">Superior Vena Cava Syndrome.Dr Amir Rezaee and Radswiki et al. Radiopedia http://radiopaedia.org/articles/superior-vena-cava-obstruction Accessed on January 13, 2016</ref>'''<ref name="pmid10682770">{{cite journal |vauthors=Erasmus JJ, Connolly JE, McAdams HP, Roggli VL |title=Solitary pulmonary nodules: Part I. Morphologic evaluation for differentiation of benign and malignant lesions |journal=Radiographics |volume=20 |issue=1 |pages=43–58 |date=2000 |pmid=10682770 |doi=10.1148/radiographics.20.1.g00ja0343 |url=}}</ref> === |
| | align="center" style="background:#f0f0f0;" |'''Signs/symptoms'''
| |
| | |
| | align="center" style="background:#f0f0f0;" |'''Tests'''
| |
| |-
| |
| |Pancoast Tumor
| |
| |The most common [[symptoms]] of Pancoast tumor include [[cough]], [[hemoptysis]], [[dyspnea]], [[chest pain]], [[lack of appetite]], [[weight loss]], [[fatigue]]. [[Symptoms]] of [[Pancoast's syndrome]] resulting from Pancoast tumor include [[shoulder pain]] along the [[vertebral border of the scapula]], [[Horner's syndrome]] and [[weakness]] of [[hand]] [[muscles]]. Less common [[symptoms]] of [[Pancoast's syndrome]] include [[paraplegia]].
| |
| |'''[[Chest x-ray]]:''' Lordotic view on [[chest x-ray]] is helpful in visualizing Pancoast tumor because of its characteristic location in the [[Apical|apical portion]] of the [[lung]]. Findings on an [[x-ray]] suggestive of Pancoast tumor include [[opacity]] at the [[apex]] of the [[lung]] or in the superior sulcus area, the spread of the [[tumor]] can result in [[rib]] [[invasion]] that is observed as a [[bone]] destruction of [[posterior]] [[ribs]], [[vertebral body]] [[Infiltration (medical)|infiltration]], [[Enlargement of organs|enlargement]] of the [[mediastinum]]. '''[[CT scan]]''' is [[diagnostic]] of Pancoast tumor. [[CT scan]] has a limited ability to determine the extent of [[invasion]] of the [[primary tumor]] into adjoining structures when compared to [[MRI scan]]. [[Subclavian|Subclavian-vessel involvement]] is assessed by [[CT scanning|contrast CT scanning]]. '''[[MRI]]''' is helpful in the [[diagnosis]] of Pancoast tumor. [[MRI]] offers greater detail in the evaluation of [[chest wall]] [[invasion]], [[examination]] of [[vascular]] structures and [[Brachial plexus|brachial plexus involvement]] and resectability of the [[tumor]]. Other [[diagnostic]] studies for evaluating the spread of Pancoast tumor include [[Scintigraphy|bone scintigraphy]], [[PET scan]], [[Molecular|molecular tests]] and [[biopsy]]. | |
| |- | |
| |[[Superior Vena Cava Syndrome]] | |
| |[[Superior vena cava syndrome]] [[patients]] gradually develop [[symptoms]] as the [[malignancies]] increase in [[Size consistency|size]]. [[Symptoms]] occur when [[obstruction]] of [[Venous blood|venous blood flow]] back to the [[heart]] increases gradually,andd may worsen with [[Postural hypotension|postural changes]]. [[Symptoms]] are quite varied among [[benign]] and [[malignant]] [[superior vena cava syndrome]]. They can range from [[sub-clinical]] presentation to death. The most common [[symptoms]] include the following [[dyspnea]], [[cough]], [[swelling]] of the [[face]], [[neck]], [[trunk]], and [[Arm|arms]]. Less common [[symptoms]] include the following [[hoarseness]], [[chest pain]], problems [[swallowing]] and/or talking, [[coughing up blood]], [[headache]], [[Swallowing|lightheadedness]], decreased [[alertness]], [[Headache|dizziness]], [[lightheadedness|fainting]], sensation of [[decreased alertness|head]] or [[decreased alertness|ear]] "fullness", [[Vision|vision changes]]. | |
| |On '''[[Chest X-ray|chest x-ray]]''', indirect [[signs]] such as [[Mediastinal widening|superior mediastinal widening]] and right [[hilar]] prominence may indicate the presence of a [[mediastinal mass]]. On enhanced '''[[CT scan]]''', findings include location and severity of the [[superior vena cava obstruction]], [[Thrombosis|superimposed thrombosis]], a [[mediastinal mass]] or [[lymphadenopathy]], [[Collateral circulation|collateral vessels]], and [[Lung mass|associated lung masses]]. [[CT scan]] is the [[imaging]] modality of choice. [[Doppler ultrasound|'''Doppler ultrasound''']] may be valuable in assessing the site and nature of the [[obstruction]] in [[superior vena cava syndrome]]. [[Venous|Venous patency]] and the presence of [[thrombi]] can also be assessed by using [[contrast]] and rapid scanning techniques. Other [[imaging]] finding is the [[Radionuclides|radionuclide]] [[technetium-99m]] [[venography]]. [[Invasive]] [[contrast]] [[venography]] may be useful on the [[etiology]] of [[obstruction]] and exact location of the obstruction, also helpful in the [[Surgery|surgical management]] of the [[Obstruction|obstructed]] [[vena cava]].
| |
| |-
| |
| | [[Thoracic outlet syndrome]]
| |
| |[[Arterial]] [[thoracic outlet syndrome]] can present with [[pallor]], [[Cold|sensation of cold]], [[pain]], and [[paresthesias]] of the [[fingers]] due to severe [[ischemia]].
| |
| | |
| [[Venous]] form (aka '''Paget-Schroetter syndrome''', '''Effort thrombosis''' and '''thoracic inlet syndrome''') presents with arm [[swelling]] and [[pain]].
| |
| |'''[[Chest radiography]]''' is helpful to evaluate presence of [[cervical]] or [[first rib]], [[Clavicle|clavicle deformity]], [[pulmonary]] [[disease]]. [[Duplex ultrasonography|Color flow duplex scanning]], [[nerve conduction studies]], [[electromyography]], or [[imaging studies]] are recommended to confirm or rule out a [[diagnosis]] of [[Thoracic outlet syndrome|Thoracic outlet syndrome(]]TOS). '''[[Nerve conduction studies|Nerve conduction]] evaluation''' via root stimulation and F wave is the best direct approach to evaluation of [[neurologic]] TOS. '''[[CT scan]]''', [[MRI]], [[Arteriography]], while only rarely used to evaluate [[Thoracic outlet syndrome|thoracic outlet syndrome]], may be used if a [[surgery]] is being planned to correct an [[arterial]] [[Thoracic outlet syndrome|TOS]]. '''[[Arteriography]]''' is indicated in the presence of [[evidence]] of peripheral [[emboli]] in the [[upper extremity]], suspected [[subclavian]] [[stenosis]] or [[aneurysm]] (e.g., [[Bruits|bruit]] or abnormal [[supraclavicular]] pulsation), [[blood pressure]] differential greater than 20 mmHg, Obliteration of [[Radial artery|radial]] [[pulse]]. '''[[Venography]]''' indications include persistent or intermittent [[edema]] of the [[hand]] or [[arm]], [[Cyanosis|peripheral unilateral cyanosis]], [[Venous|prominent venous pattern]] over the [[arm]], [[shoulder]], or [[chest]]. '''[[Thermography]]''' indications are [[vasomotor]] or [[sudomotor]] [[instability]], [[Sensitivity|weather sensitivity]], cold limb in a shawl or [[C8|C8 distribution]]. [[Thermography]] may be one of the most sensitive tests to objectify the presence of [[thoracic outlet syndrome]], especially if it is felt to be [[sympathetic]] in [[origin]]
| |
| |-
| |
| |'''[[Cervical Disc Disease|Cervical Disk Disease]]'''
| |
| |With [[symptomatic]] [[degenerative]] [[disc disease]], [[chronic]] [[shoulder pain]] sometimes radiates to the [[arm]] that may be associated with sporadic [[tingling]] or [[weakness]] may also be evident. Similar [[pain]] may be felt or may increase with [[range of motion]] of [[shoulder joint]]. While the [[degeneration]] of the [[Disc disease|disc]] will likely progress as a natural part of the [[aging]] [[Process (anatomy)|process]], [[symptoms]] such as [[neck]] and [[shoulder pain]] often decrease over time.
| |
| |
| |
| |-
| |
| | |
| | '''[[Pneumonia]]/[[bronchitis]]'''||Typical [[symptoms]] include [[fever]], [[cough]], [[dyspnea]], and [[chest pain]]; [[Pneumonia|recurrent pneumonia]] or [[bronchitis]] in a [[Smoker's cough|smok]]<nowiki/>formerformer [[Smoking|smoker]] should raise the suspicion of [[lung cancer]]||'''[[Chest X-Ray]]''' is the first [[test]] performed; '''[[CT-scans|CT imaging]]''' can be helpful to evaluate [[pulmonary]] [[Mass|masses]] that might not be well visualised with [[chest x-ray]]; '''[[bronchoscopy]]''' can also be used to assess for endobronchial [[Lesion|lesions]] or to [[biopsy]] suspicious [[pulmonary]] [[Mass|masses]]
| |
| | |
| |-
| |
| | |
| | '''[[Carcinoid tumor]]'''||Often [[asymptomatic]] with normal [[physical examination]]; may cause [[cough]], [[dyspnea]], [[hemoptysis]], [[Wheezing|unilateral wheezing]], or [[Pneumonia|post-obstructive pneumonia]] if the [[tumor]] is endobronchial or compressing the [[Bronchi|central bronchi]]. ||'''[[CT-scans|CT chest:]]''' 80% of [[carcinoid tumors]] appear as an endobronchial [[nodule]] and 20% as a [[parenchymal]] [[nodule]], with smooth, rounded borders and is highly [[Vascularity|vascularized]]; '''[[bronchoscopy|flexible bronchoscopy]]''' shows raised, pink, [[vascular]], [[Lobule|lobulated]] [[lesions]]; '''endobronchial forceps [[biopsy]]''' is usually required for [[pathology]] to be [[diagnostic]]; [[Brushing|bronchial brushings]], [[Sputum|sputum specimens]], and lavage [[fluid]] rarely provide sufficient [[tissue]] for a conclusive [[diagnosis]]
| |
| | |
| |-
| |
| | |
| | '''[[Metastatic]] [[cancer]] from a non-thoracic primary site'''||[[Signs]] and [[symptoms]] depend on the location of the [[primary tumor]] and [[Disease|distant disease]] and may include [[pain]], [[weight loss]], [[malaise]], [[cough]], [[dyspnea]], [[clubbing]], or [[Wheezing|focal wheezing]]; [[Physical Examination|physical]] findings may be present depending on the location and extent of the [[disease]]||'''[[CT|CT chest]]''' shows one or multiple [[nodules]] of variable [[Size consistency|sizes]] from [[diffuse]] micronodular [[Opacity|opacities]] (miliary) to well-defined [[Mass|masses]], [[lesions]] are often irregular and in the periphery of the lower [[Lung|lung zones]]; '''[[CT]]/[[MRI]] [[head]], [[CT|CT abdomen and pelvis]]:''' extrapulmonary [[cancers]] that commonly [[metastasis]] to the [[lung]] include [[melanoma]], [[thyroid]] [[carcinoma]], [[esophageal cancer]]; [[ovarian cancer]]; [[sarcomas]]; and [[adenocarcinomas]] of the [[colon]], [[breast]], [[kidney]], and [[testis]]; '''[[Positron emission tomography|PET-FDG scan]]''' shows increased uptake in both primary and distant sites, certain [[metastatic]] [[lesions]], such as [[renal cell carcinoma]], have a lower probability of 18-fluorodeoxyglucose (FDG) uptake; '''CT-guided transthoracic needle aspiration (TTNA)''' can reveal characteristic [[Malignant|malignant cells]], [[pneumothorax]] complicates 20% to 30% of TTNA procedures, the choice between [[bronchoscopy]] and TTNA is based on [[Lesion|lesion size]], location, [[risks]], and local expertise; '''[[biopsy]] during [[Bronchoscopy|flexible bronchoscopy]] and [[biopsy]]''' may show characteristic [[malignant]] [[cells]], [[bronchoscopy]] has a 100% yield for endobronchial [[lesions]] (which are extremely rare in [[metastatic]] deposits from other [[Primary tumor|primary tumors]])
| |
| | |
| |-
| |
| | |
| | '''[[Granuloma|Infectious granuloma]]'''||History may include travel to endemic areas, pet/animal exposures, and specific leisure activities (e.g., caving); may feature [[cough]], [[dyspnea]], [[hemoptysis]], [[weight loss]], [[fever]], [[joint aches]], [[skin lesions]], and [[night sweats]], or no [[symptoms]]; many possible [[causes]]: ''[[Histoplasma capsulatum]]'', ''[[Mycobacterium tuberculosis]]'', ''[[Coccidioides immitis]]'', ''[[Cryptococcus neoformans]]'', ''[[Aspergillus]]'', ''[[Pseudallescheria boydii]]'', ''Fusarium'' species, [[zygomycetes]], and others; non-specific [[skin]] [[Urine|findings]] may be seen in [[atypical mycobacteria]] and [[cryptococcosis]]; [[lymphadenopathy]] may be present with active [[disease]]||'''CT-guided TTNA''' can be used for [[diagnostic]] [[sampling]], [[pneumothorax]] complicates 20% to 30% of TTNA [[Procedure|procedures]], the choice between [[bronchoscopy]] and TTNA is based on [[lesion]] [[Size consistency|size]], [[Location parameter|location]], [[risks]], and local expertise; '''[[CT]] [[chest]]''' typically shows [[lesions]] <2 cm [[diameter]] and round with smooth borders, old [[granulomatous]] [[disease]] may feature [[central]], laminated, or [[diffuse]] [[calcification]] [[pattern]], [[mediastinal]] [[lymphadenopathy]] without [[Calcification|calcifications]] is sometimes present, [[nodules]] from angioinvasive [[fungi]] (e.g., [[Aspergillus]], [[Pseudallescheria boydii]], [[Fusarium|Fusarium species]], and [[zygomycetes]]) may demonstrate the "[[halo sign]]" (ground-glass [[opacity]] surrounding the [[nodule]]), occasionally, [[Calcification|calcifications]] can be seen in the [[spleen]] or [[liver]]; '''[[fungal]] [[Serological testing|serologies]]:''' positive during active [[infection]]; '''[[Bronchoscopy|flexible bronchoscopy]] and [[biopsy]]''' can sometimes provide sample for identification and culture and [[sensitivity]] of [[Organisms|organism]]; '''[[PET scan|PET]]:''' usually negative (<2.5 standardised uptake values), may be positive in active [[infectious]] [[Process (anatomy)|processes]]
| |
| | |
| |-
| |
| | |
| | '''[[Sarcoidosis]]'''||[[Cough]], [[dyspnea]], [[fatigue]], [[weight loss]], [[fever]], [[night sweats]], [[rash]], [[eye pain]], [[photophobia]], [[blurred vision]], and [[red eye]]; [[pulmonary]] [[examination]] is usually unrevealing; can affect any [[Organ (anatomy)|organ]], so [[Physical examination|physical findings]] depend on specific [[organs]] affected; [[skin lesions]] including [[maculopapular]] [[Eruption|eruptions]], [[subcutaneous]] [[nodular]] [[lesions]], and red-purple [[skin lesions]]||'''[[CT]] [[chest]]:''' [[mediastinal]] [[adenopathy]] often present with [[sarcoid]]. [[Sarcoid]] [[nodules]] have predilection for upper zones, although can be located throughout the [[lung]]; '''[[Bronchoscopy|flexible bronchoscopy]] and [[biopsy]]''' can demonstrate presence of non-caseating [[granulomas]]; '''[[CT-scans|CT-guided]]''' '''TTNA''' can provide access to material from some [[lesions]] inaccessible to [[Bronchoscopy|flexible bronchoscopy]]; '''[[Laboratory|laboratory markers]]:''' [[Angiotensin-converting enzyme|ACE elevation]] may be seen in [[sarcoidosis]] but is non-specific.
| |
| | |
| |-
| |
| | |
| | '''[[Rheumatoid arthritis]]'''||[[Arthralgias]], [[pain]], [[skin nodules]], [[pleural effusions]], [[pleuritis]], [[joint pain]], and [[deformity]]||'''[[CT]] [[chest]]''' typically shows [[lung]] [[nodule]] 3 mm to 7 cm, predominantly in peripheral upper and mid-[[lung]] zones, may show [[cavitation]]; '''[[Bronchoscopy|flexible bronchoscopy]] and [[biopsy]]''' shows [[Rheumatoid Arthritis|rheumatoid]] necrobiotic [[nodule]], necrobiotic [[nodules]] demonstrate a central zone of [[eosinophilic]] [[fibrinoid necrosis]] surrounded by palisading [[fibroblasts]], the [[nodule]] often centered on [[necrotic]] [[inflamed]] [[blood]] [[vessels]]; '''[[Laboratory medicine|laboratory markers]]:''' [[patients]] with [[lung]] [[nodules]] due to [[rheumatoid arthritis]] frequently have high levels of [[rheumatoid factor]], although [[seronegative]] cases have been reported.
| |
| | |
| |-
| |
| | |
| | '''[[Wegener's granulomatosis]]'''||[[Cough]], [[chest pain]], [[dyspnea]], [[hemoptysis]], [[rhinorrhoea]], [[epistaxis]], [[ear]]/[[sinus]] [[pain]], [[hoarseness]], [[fever]], [[fatigue]], [[anorexia]], [[weight loss]], [[palpable]] [[purpura]], [[painful]] [[ulcers]], [[uveitis]], [[upper airway]] [[inflammation]], and [[sinus]] [[pain]]||'''[[CT-scans|CT]] [[chest]] shows''' [[solitary]] or multiple [[lung]] [[nodules]], [[airways]] are frequently affected; '''[[Bronchoscopy|Flexible bronchoscopy]] or [[CT-scans|CT]]-guided TTNA''' may show [[Necrotizing|necrotising]] [[granulomatous]] [[inflammation]]; '''[[Laboratory medicine|laboratory markers]]:''' [[anti-neutrophil cytoplasmic antibody]] ([[ANCA]]), [[ANCA]] [[testing]] results depend on the extent and severity of the [[disease]].
| |
| | |
| |-
| |
| | |
| | '''[[Arteriovenous malformation]]'''||[[Dyspnea]] is uncommon, may cause [[hemoptysis]], [[pulmonary]] [[bruit]], [[Arteriovenous Fistula|arteriovenous communications]], or [[hemorrhagic]] [[telangiectasia]] in the [[skin]], [[mucous membranes]], and other [[organs]], [[cyanosis]] and [[finger clubbing]] may be present, [[Neurological illness|neurological]] [[symptoms]] from [[cerebral]] [[aneurysms]], [[cerebral]] [[emboli]]||'''[[CT-scans|CT]] [[chest]]''' shows round or oval [[nodule]](s) with feeding [[artery]] and draining [[vein]] often identified, most common in lower [[lobes]], multiple [[lesions]] in 30% of cases, usually round or oval, ranging from 1 cm to several cm in diameter; '''[[pulmonary]] [[angiography]]''' confirms presence and location of [[Arteriovenous malformation|AVMs]], identifies feeding [[arterial]] and [[venous]] structures, in cases of significant [[hemoptysis]], [[pulmonary]] [[angiogram]] is combined with [[bronchial]] [[artery]] [[embolisation]]; '''[[Arterial blood gas|ABG]] [[analysis]]''' may show decreased pO2 and decreased [[oxygen saturation]] when AV flow is severe., in cases of severe [[systemic]] [[Arteriovenous malformation|AVMs]], [[chronic]] [[hypoxemia]] may cause [[polycythemia]]
| |
| | |
| |-
| |
| | |
| | '''[[Amyloidosis]]'''||[[Weight loss]], [[paresthesias]], [[dyspnea]], and [[fatigue]] are the most common [[symptoms]] associated with [[amyloidosis]] and are common to all [[systemic]] forms; [[weight loss]] of >9 kg is common; small [[vessel]] involvement can cause [[jaw]] or [[limb]] [[claudication]], and rarely [[angina]]; [[amyloid]] [[purpura]] is present in about 1 in 6 [[patients]], typically [[Orbital cavity|peri-orbital]]; [[eyelid]] [[petechiae]] are common; [[hepatomegaly]] >5 cm below the right [[costal]] margin is seen in 10% of [[patients]] and [[splenomegaly]] is usually of modest degree.||'''[[CT]] [[chest]]''' shows [[lung]] involvement characterised by focal [[pulmonary]] [[nodules]], [[Tracheobronchial|tracheobronchial lesions]], or [[diffuse]] [[alveolar]] deposits; '''[[serum]] [[immunofixation]]''' shows presence of [[monoclonal]] [[protein]]; [[urine]] [[immunofixation]] shows presence of [[monoclonal]] [[protein]]; '''[[immunoglobulin]] free [[light chain]] [[Assays|assay]]''' shows [[abnormal]] kappa to [[Lambda (anatomy)|lambda]] [[ratio]].
| |
| | |
| |-
| |
| | |
| | '''[[Pulmonary tuberculosis]]'''||[[Cough]] longer than 2 to 3 weeks, discolored or [[Bloody sputum|bloody]] [[sputum]], [[night sweats]], [[weight loss]], [[loss of appetite]], and/or [[pleuritic]] [[chest]] [[pain]].||'''[[Chest X-ray|Chest x-ray]]:''' primary disease commonly presents as middle and lower [[lung]] zone infiltrates, [[ipsilateral]] [[adenopathy]], [[atelectasis]] from [[airway]] compression, and [[pleural effusion]] can be seen, reactivation-type (post-primary) [[pulmonary]] [[TB]] usually involves [[apical]] and/or [[posterior]] segment of right upper [[lobe]], apicoposterior segment of left upper [[lobe]], or superior segment of either lower [[lobe]], with or without [[cavitation]], as [[disease]] progresses it spreads to other segments/[[lobes]]; '''[[sputum]] [[Smear test|smear]]:''' positive for [[acid-fast bacilli]] ([[AFB]]), [[sputum]] may be spontaneously [[Expectorate|expectorated]] or induced, and at least 3 specimens should be collected (minimum 8 hours apart, including an early morning specimen, which is the best way to detect ''[[Mycobacterium tuberculosis]]'', [[organisms]] other than ''[[M. tuberculosis]]'', especially on-[[Mycobacteria|tuberculous mycobacteria]] (e.g., ''[[M. kansasii]]'' and ''M. avium'' , may be positive for [[AFB stain]]; '''[[Nucleic acid amplification technique|nucleic acid amplification tests]] [[NAAT|(NAAT)]]:''' positive for ''[[M. tuberculosis]]'' [[DNA]] or [[RNA]] [[amplification]] [[Test|tests]] for rapid [[diagnosis]], may be used on [[sputum]] or any [[sterile]] [[body]] [[fluid]].
| |
| | |
| |-
| |
| | |
| | '''[[Non-Hodgkin's lymphoma]] ([[NHL]])'''||Aggressive [[NHL]] may present with [[fever]], [[Night sweats|drenching night sweats]], [[malaise]], [[weight loss]], [[cough]], [[shortness of breath]], [[abdominal discomfort]], [[headache]], change in [[mental status]], [[dizziness]], [[ataxia]], [[pleural effusion]], [[lymphadenopathy]], [[pallor]], [[purpura]], [[jaundice]], [[hepatomegaly]], [[splenomegaly]], [[skin]] [[nodules]], and abnormal [[neurological]] [[examination]], low-grade [[NHL]] [[patients]] often minimally [[symptomatic]] or [[asymptomatic]].||'''[[Computed tomography|CT]] [[chest]]:''' frequently [[anterior]] [[mediastinum]], can determine if [[mass]] is [[cystic]] or [[solid]] and whether it contains [[calcium]] or [[fat]], [[contrast]] enhancement provides information concerning vascularisation of the [[mass]] and relationship to adjacent structures; '''FBC with differential:''' shows [[thrombocytopenia]], [[pancytopenia]]; '''[[Blood smear]]:''' shows [[nucleated]] [[red blood cells]], [[Platelets|giant platelets]]; '''[[Lymph nodes|lymph node]] [[biopsy]] with [[immunohistochemistry]]:''' shows characteristic [[cells]], preferably obtain [[Excisional biopsy|excisional]] or core [[biopsy]] to provide information on [[lymph node]] architecture; '''[[mediastinoscopy]]:''' used to sample [[mediastinal]] [[Lymph node|nodes]].
| |
| | |
| |-
| |
| | |
| | '''[[Hodgkin's lymphoma]]'''||Predominantly a [[disease]] of [[young adults]]; most [[patients]] present with a several-month history of persistent [[adenopathy]], most commonly of the [[cervical]] chain.||'''[[Chest x-ray|Plain chest x-ray:]]''' typically shows [[mediastinal]] [[mass]]/large [[mediastinal]] [[adenopathy]]; '''[[PET scan|PET scan:]]''' involved sites appear fluorodeoxyglucose (FDG)-avid (bright) with [[Positron emission tomography|PET imaging]]; '''[[lymph node]] [[biopsy]] with [[immunohistochemistry]]:''' the [[Hodgkin's]] [[cell]] can be a characteristic [[Reed-Sternberg cells|Reed-Sternberg cell]], or one of its variants, such as the lacunar [[cell]] in the [[nodular sclerosis]] subtype; in [[Nodular lymphocyte predominant Hodgkin lymphoma|nodular lymphocyte-predominant Hodgkin's lymphoma]], the characteristic [[cell]] is the [[lymphocytic]] and [[histiocytic]] (L&H) [[cell]], also referred to as a [[popcorn]] [[cell]].
| |
| | |
| |-
| |
| | |
| | '''[[Thymoma]]/[[Thymic carcinoma]]'''||Approximately 30% of [[patients]] with [[thymoma]] are [[asymptomatic]] at the time of [[diagnosis]]; may also present with [[cough]], [[chest pain]], [[signs]] of upper [[Airway constriction|airway congestion]], [[superior vena cava syndrome]], [[dysphagia]], or [[hoarseness]]; may have features of [[paraneoplastic syndromes]] associated with [[thymoma]] including [[myasthenia gravis]], [[polymyositis]], [[lupus erythematosus]], [[rheumatoid arthritis]], thyroiditis, and [[Sjogren's syndrome]]; about 30% of [[patients]] have [[symptoms]] suggestive of [[myasthenia gravis]] (e.g., [[ptosis]], [[double vision]])||'''[[Chest x-ray|Plain chest x-ray:]]''' in 50% of the [[patients]], [[thymomas]] are detected by chance with [[Chest radiography|plain-film chest radiography]]; [[CT]] [[chest]]: 90% occur in [[anterior mediastinum]]; '''[[Positron emission tomography|Positron emission tomography (PET):]]''' may be of value in determining [[malignancy]] and extramediastinal involvement; '''[[Biopsy|pre-operative biopsy]]:''' indicated if there are atypical features or if [[imaging]] suggests [[invasive]] [[tumor]] and [[patient]] is under consideration for [[Induction (biology)|induction therapy]]
| |
| | |
| |-
| |
| | |
| | '''[[Bronchogenic cyst]]'''||Usually [[Diagnosis|diagnosed]] in [[infancy]] and [[childhood]], although 50% are [[Diagnosis|diagnosed]] after 15 years of age; Approximately 50% of [[patients]] are [[asymptomatic]]; in [[Adult|adults]], [[chest pain]] (often [[pleuritic]]) and [[dysphagia]] (due to [[Esophageal|esophageal compression]]) are the most [[Symptoms|common symptoms]]; may also feature recurrent [[cough]] and [[chest]] [[infection]]/[[pneumonia]], [[superior vena cava syndrome]], [[tracheal compression]], and [[pneumothorax]]||'''[[Chest radiography|Two-view chest radiography:]]''' typically shows a sharply demarcated spherical mass of variable [[Size consistency|size]], most commonly located in the [[middle mediastinum]] around the [[carina]], can appear as a [[Solid tumors|solid tumor]] or show air-fluid level if [[cyst]] is [[infected]] or contains [[secretions]]; '''[[CT|CT chest:]]''' frequently [[middle mediastinum]], typically at level of the [[mediastinum]], [[Calcification|calcifications]] may also be seen; '''[[MRI]]:''' frequently [[middle mediastinum]], typically at level of the [[mediastinum]], T2-weighted [[images]] show a [[homogeneous]] [[mass]] of moderate-to-bright intensity, on T1-weighted [[images]], [[lesions]] may vary in [[intensity]] depending on [[protein]] content of the [[cyst]].
| |
| | |
| |-
| |
| | |
| | '''[[Tracheal tumors]]'''||Common [[symptoms]] include [[dyspnea]], [[cough]], [[hemoptysis]], [[wheeze]], and [[stridor]]; less commonly, [[hoarseness]] and [[dysphagia]] may be present||'''[[Chest radiograph|Plain chest radiographs]]''' are generally insensitive for detection of [[Tracheal bronchus|tracheal]] [[tumors]], clues that may indicate the presence of a [[Tracheal bronchus|tracheal]] [[tumour]] include abnormal [[calcification]], [[Tracheal bronchus|tracheal]] narrowing, [[Pneumonia|post-obstructive pneumonia]], and/or [[atelectasis]]; '''[[Helical CT scan|helical CT]]''' enables accurate calculation of [[tumor]] volumes and can help differentiate [[mucosal]] [[lesions]] from [[Submucosal|submucosal lesions]]; '''[[MRI]]''' can be useful in assessing [[extension]] into [[Tissue|surrounding tissue]] and [[vascular]] [[anatomy]]; '''[[bronchoscopy]]''' allows direct visualisation, opportunity for [[biopsy]], and potential for [[laser]] treatment.
| |
| | |
| |-
| |
| | |
| | '''[[Thyroid]] [[mass]]'''||[[Symptoms]] and [[signs]] depend on [[Size consistency|size]] of [[mass]]; may be visible/palpable as [[lump]] on anterior aspect of [[neck]]; may present with [[dysphagia]], [[hoarseness]], [[difficulty breathing]], and [[pain]] in [[neck]] or [[throat]]; may also be [[signs]] and [[symptoms]] of hyper- or [[hypothyroidism]] depending on the nature of the [[mass]].||'''[[Laboratory]] [[testing]]''' should include [[thyroid]] [[Function (biology)|function]] panel, with [[TSH]], free [[T4]], free [[T3]]; [[I-123 thyroid imaging|I-123 thyroid scan]] is ordered for [[patients]] with overt or [[subclinical]] [[hyperthyroidism]] a hyperfunctioning (hot) [[Nodules|nodule]] is almost always [[benign]], most [[nodules]] are [[Hypofunctioning thyroid|hypofunctioning]] ([[cold]]) (most of these are [[benign]], but [[malignant]] [[nodules]] are also [[cold]]); '''[[ultrasound]] and [[doppler]]''' can be used to define [[Dimension|dimensions]] of [[Thyroid nodule|thyroid nodules]] and [[solid]]/[[cystic]] component(s), features suspicious of [[malignancy]] include [[Microcalcification|microcalcifications]], a more tall-than-wide shape, [[Vascularity|hypervascularity]], marked [[Echogenicity|hypoechogenicity]], or irregular margins, it can also [[Fine-needle aspiration|guide fine-needle aspiration]], which can reveal [[malignant]] [[cells]] or [[Cyst|cyst fluid]]; '''[[CT]] [[neck]]''' can evaluate [[cervical]] [[lymph]] [[Lymph node|nodes]] in cases of [[medullary]] [[thyroid]] [[cancer]], and extension of the [[scan]] into the [[chest]] can help evaluate a retrosternal [[thyroid]] [[mass]]
| |
| | |
| |}
| |
| === '''The following table summarizes the differentiation of various lung tumors based on histological and topographical features:'''<ref name="pmid10682770">{{cite journal |vauthors=Erasmus JJ, Connolly JE, McAdams HP, Roggli VL |title=Solitary pulmonary nodules: Part I. Morphologic evaluation for differentiation of benign and malignant lesions |journal=Radiographics |volume=20 |issue=1 |pages=43–58 |date=2000 |pmid=10682770 |doi=10.1148/radiographics.20.1.g00ja0343 |url=}}</ref> ===
| |
| {| class="wikitable" | | {| class="wikitable" |
| ! colspan="11" |Abrevations: | | ! colspan="11" |Abrevations: |
