Presentations Flashcards
Pancoast Tumor
Tumor of the lung apex
Symptoms of pancoast tumor
Symptoms often involve the C8 and T1 nerves within the brachial plexus
Symptoms are distributed in the C8, T1 and T2 dermatomes and mimic thoracic outlet syndrome
What leads to Homer’s syndrome?
Extension into the paravertebral sympathetic nerves
Signs of Homer’s syndrome?
Enophthalmos
Ptosis
Miosis
Most common initial symptom of pancoast tumor?
sharp shoulder pain (usually posterior)
Nagging-type pain in the shoulder and along the vertebral border of the scapula.
Pain in the axilla and subscapular areas on the affected side
Pulmonary symptoms of Pancoast tumor:
Cough, hemoptysis and dyspnea are uncommon until later in the disease
Pulmonary red flags:
Shoulder pain
Onset of pulmonary symptoms in any patient with neck, shoulder, and/or arm pain
Homer’s syndrome
Ipsilateral flushing and hyperhydrosis (excessive sweating) of the face
Standard of care treatment of Pancoast Tumor:
induction chemo-radiotherapy followed by surgical resection
Where does Pancoast tumor usually invade?
chest wall, brachial plexus, and spine or subclavian vessels
MSK differential diagnosis of Pancoast tumor:
thoracic outlet trigger points of serratus anterior cervical OA shoulder bursitis RTC injury
Non MSK differential diagnosis of Pancoast tumor:
other tumors
infections and inflammatory lung disease
vascular lesion
Pneumothorax
a collection of air in the pleural cavity resulting in collapse of the lung on the affected side
Two common classifications of pneumothorax:
Tension
Spontaneous
Tension pneumothorax:
Usually a consequence of trauma
Signs oft tension pneumothorax:
Severe “pleuritic-type” chest wall pain, extreme SOB, tracheal deviation (away from involved side), distended neck veins, tachycardia, hypotension, hyper resonance
Treatment of tension pneumothorax:
medical emergency
Chest tube
Needle thoracostomy
Spontaneous pneumothorax:
Usually pathologic event associated with rupture lung wall
Air may escape into pleural space from a puncture or tear in an internal respiratory structure
Signs of spontaneous pneumothorax:
Pain with deep inspiration, decreased chest expansion, hyper resonance, marked decreased breath sounds (affected side).
Causes of spontaneous pneumothorax:
No precipitating event or after extreme coughing/strenuous physical activity
Traumatic pneumothorax
Follows a penetrating chest trauma
Iatrogenic pneumothorax
May follow a number of procedures
mechanical ventilation and interventional procedures
Catamenial pneumothorax
Pneumothorax at the time of menstruation
Ideopathic spontaneous pneumothorax
Result of leakage of air from the lung parenchyma through a ruptured viscera pleura into pleural cavity
Risk factors for pneumothorax:
scuba diving overexertion surgery involving chest MVA, Chest or thorax pulmonary disease
Patient presentation of pneumothorax:
abrupt onset of dyspnea
severe pain in upper and lateral thoracic wall
sudden onset of pain
comfortable sitting in upright position
Hallmark findings of pneumothorax:
dyspnea change in respiratory movement shoulder pain fall in BP weak and rapid pulse
What pulse rate indicates pneumothorax?
above 135 bpm
Pneumonia
the inflammation of the parenchymal structures of the lung.
Bacterial pneumonia
typically acquired by inhaling infectious droplets that reach mucous membranes of the alveoli or aspirating into the upper respiratory airways.
Atypical pneumonias
are from viral and mycoplasma infections that reside in the alveolar septum and the interstitium of the lung. These manifest milder symptoms and physical signs than bacterial pneumonia.
Patient presentation of pnemonia:
tachypnea (ventilation rate greater than 20 BPM) fever shallow respiration fatigue muscular and abdominal pain cough pain
With pneumonia, increased hospital mortality associated with
age over 65 neurological disease chronic liver disease absence of chest pain tachypnea diastole hypotension
MSK differential diagnosis of pneumonia:
chostochondritis
SC joint injury
shoulder pain
rib injury
Red Flags for Abdominal/Chest Pain
Pain that changes location Pain that awakens from sleep Weight Loss Pain that persists for longer than 6 hours or worsens Pain followed by vomiting.
