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  • A. Cancerul Centrohilar: Diagnostic Diferential

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    StanicaDenisse
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    This document discusses the differential diagnosis for various forms of lung cancer seen on anatomical and radiological imaging. It describes 7 main categories: 1) Central hilar cancer, 2) Parahilar cancer, 3) Peripheral cancer, and 4) Some particular forms including lobular cancer, paramediastinal cancer, and corticopleural cancer. For each category, it lists potential alternative diagnoses that should be considered based on presenting symptoms and imaging findings.

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    Diag Diferential

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    This document discusses the differential diagnosis for various forms of lung cancer seen on anatomical and radiological imaging. It describes 7 main categories: 1) Central hilar cancer, 2) Parahilar cancer, 3) Peripheral cancer, and 4) Some particular forms including lobular cancer, paramediastinal cancer, and corticopleural cancer. For each category, it lists potential alternative diagnoses that should be considered based on presenting symptoms and imaging findings.

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    30 views4 pages

    A. Cancerul Centrohilar: Diagnostic Diferential

    Uploaded by

    StanicaDenisse
    This document discusses the differential diagnosis for various forms of lung cancer seen on anatomical and radiological imaging. It describes 7 main categories: 1) Central hilar cancer, 2) Parahilar cancer, 3) Peripheral cancer, and 4) Some particular forms including lobular cancer, paramediastinal cancer, and corticopleural cancer. For each category, it lists potential alternative diagnoses that should be considered based on presenting symptoms and imaging findings.

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    of 4

    Diagnostic diferential

    • In functie de forma anatomo-radiologica

    A. Cancerul centrohilar
    – Intereseaza bifurcatia, bronhiile primitive si segmentele proximale ale
    bronhiilor lobare
    – RX pulmonar: ingrosare si intensificare a umbrei hilare, omogena
    Diagnostic diferential - Cancerul centrohilar
    1. Adenopatia hilara bacilara:
    • Unilaterala/bilaterala, BK pozitiv in sputa
    2. Limfogranulomatoza maligna:
    • Bilaterala, invadeaza parenchimul + adenopatii periferice,
    splenomegalie
    3. Sarcoidoza:
    • Bilaterala, VSH normal, bronhoscopie negativa
    4. Limfoblastomul giganto-folicular (Sdr. Brill-Symmers):
    • Adenopatia mediastinala apare tardiv dupa cea cervicala
    • Asociaza splenomegalie
    • Bioipsie: folicul mare cu limfoblasti
    5. Limfomul luetic:
    • Unilaterala dar prezenta si in alte teritorii + RBW pozitiv
    6. Leucemia limfatica cronica:
    • Bilaterala + limfocitoza sanguina
    7. Limfo- sau reticuloblastom mediastinal
    8. Silicoza:
    • Adenopatie bilaterala
    • Pot exista si noduli pulmonari
    • Asociaza emfizem bazal
    9. Tumori pulmonare benigne:
    • Conturul formatiunii tumorale este net
    • Nu cresc in volum in timp
    • Neurinoame, angioame, teratoame
    10.Organe mediastinale ce pot da umbre hilare:
    • Tiroida plonjanta
    • Ectazii aortice

    B. Cancerul parahilar
    Corespunde afectarii bronhiilor lobare in portiunea lor distala si a
    celor segmentare in portiunea lor proximala
    Obstructia bronhiilor segmentare duce la aparitia precoce a
    atelectaziei segmentare
    Umbra hilara este normala si formatiunea tumorala este adesea mascata
    de atelectazie
    Diagnostic diferential - Cancerul parahilar
    1. Pneumonia interstitiala cronica:
    • Stare subfebrila, tuse iritativa, expectoratie mucoasa sau muco-
    purulenta
    • RX – condensare pseudotumorala
    2. Abcesul pulmonar neevacuat:
    • Dupa evacuare ia aspectul unei cavitati
    • Imagine ce poate fi intalnita si in cancerul excavat
    3. Chist hidatic pulmonar:
    • Imagine rotunda, bine delimitata
    • Reactia Cassoni pozitiva
    4. Lobita tuberculoasa:
    • Instalare mai lenta
    • Aspect neomogen
    • Baciloscopie pozitiva

    C. Cancerul periferic:
    – Se dezvolta in bronhiile segmentare sau subsegmentare
    – Radiologic → opacitate macronodulara rotunda, de intensitate
    supracostala, omogena, cu contur relativ bine delimitat
    Diagnostic diferential – Cancerul periferic
    1. Tuberculomul:
    2. Goma sifilitica:
    • Evolutie rapida spre ulcerare
    • RBW pozitiva
    3. Metastaza pulmonar unica:
    • De la un neoplasm cu alt punct de plecare
    4. Aspergilom:
    • Localizat frecvent la varf
    • Da hemoptizii
    • Prezenta fungilor in sputa elucideaza diagnosticul
    5. Chist hidatic
    6. Infarct pulmonar rotund
    7. Chist bronhogen
    D. Forme particulare:
    1. Forma lobara (lobita canceroasa):
    • Extinderea cancerului la nivelul unui intreg lob
    • Rx: opacifiere intensa, omogena, ce cuprinde tot teritoriul
    lobului, cu delimitare neta scizurala
    • Diagnostic diferential cu:
    1. Lobita tuberculoasa
    2. Pneumonia cronica
    2. Forma paramediastinala:
    • Punctul de plecare este la nivelul bronhiilor din vecinatatea
    mediastinului
    • Diagnostic diferential cu:
    1. Tumori maligne mediastinale: limfosarcomul,
    reticulosarcomul, limfogranulomul malign
    3. Forma corticopleurala:
    • Mai ales forma apicala cu sindrom Pancoast-Tobias (plexita
    brahiala, lize costale, sdr. Claude-Bernard-Horner)
    • Diagnostic diferential cu:
    1. Reumatismul articular
    2. Periartrita scapulohumerala
    3. Nevrita brahiala
    4. Corticopleurita tuberculoasa

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