Pulmo. pancoast, sickle, mesotel, bronc carcinoid 10-29 (1) Flashcards
pancoast. shoulder?
shoulder pain (most common) due to brachial plexus
pancoast. horner?
ipsilateral ptosis, miosis, enophthalmos, anhidrosis
due to involvement of paravertebral sympathetic chain and inferior cervical ganglion (stellate ganglion)
pancoast. neurologic?
invasion of C8-T2 nerves (ulnar)
weakness and atrophy of intrinsic hand muscles
Pain/paresthesia of 4th/5th digits and medial arm/forearm
pancoast. weight and lymph?
Supraclavicular lymph node enlargement
weight loss
pancoast = superior pulmonary sulcus tumor.
what most common? 2
Squamous cell lung carcinoma and lung adenocarcinoma
also can occur from non-hodgkin lymphoma
pancoast. strongest risk factor?
smoking
pancoast. location?
near thoracic inlet
pancoast. symptoms?
Symptoms:
a. Weight loss
b. Arm pain and paresthesia
c. Weakness of arm and hand
d. Referred shoulder pain
e. Horner syndrome
f. Hoarseness (due to recurrent laryngeal nerve involvement)
g. Superior vena cava syndrome
pancoast. Superior vena cava syndrome presentation?
edema in face and hands
pancoast. why hoarseness?
recurrent laryngeal nerve involvement.
pancoast. investigation?
xray
Note: lung cancer can occur as a secondary malignancy (18.5 higher risk) in those who were treated with chemotherapy for cancers before the age of 30, especially in smokers. Other secondary malignancies: breast, thyroid, bone and gastrointestinal tumors.
.
mezothelioma. arise from what?
mesothelial lining
mezothelioma. exposure to what?
asbestos
mezothelioma. cp?
cough, chest pain, dyspnea
mezothelioma. diagnosis?
xray - pleural thickening with effusion
HODGKIN LYMPHOMA TREATMENT COMPLICATIONS. in what patients?
Patients, especially those treated before age 30, can develop secondary malignancies from chemotherapy and/or radiation
HODGKIN LYMPHOMA TREATMENT COMPLICATIONS. most common secondary solid-maligancies?
Most common secondary solid malignancies:
a. Lung (especially in smokers)
b. Breast
c. Thyroid
d. Bone
e. Gastrointestinal (eg, colorectal, esophageal, gastric tumors)
OTHER:
Other malignancies:
a. Acute leukemia
b. Non-Hodgkin lymphoma
HODGKIN LYMPHOMA TREATMENT COMPLICATIONS. differential?
a. Radiation fibrosis
i. Chest pain occurs 4-24 months after therapy
ii. Chest X-ray shows volume loss with coarse opacities
chronic dyspnea in sickle cell. table.
Cause - asthma. symptoms?
intermitent/chronic wheezing
may be worse at night or with exercise or upper respiratory infection
chronic dyspnea in sickle cell. table.
Cause - PH. symptoms?
exertional dyspnea
signs of right-sided heart failure (JV distension, edema)
chronic dyspnea in sickle cell. table.
Cause - pulmonary fibrosis. symptoms?
exertional dyspnea
progressive
chronic dyspnea in sickle cell. table.
Cause - asthma. diagnostic findings?
PFT showing reversible airway obstruciton
chronic dyspnea in sickle cell. table.
Cause - PH. diagnostic findings?
tricuspid regurgitation on cardioecho
incr. pulmo artery pressure on right sided heart cath.
chronic dyspnea in sickle cell. table.
Cause - pulmonary fibrosis. diagnostic findings?
honeycomb pattern on chest CT
PFT shows restrictive pattern
infections in sickle cell. table.
pneumonia?
strep pneumonia
infections in sickle cell. table.
osteomyelitis/sept arthritis?
stap. aureus
salmonella spp
infections in sickle cell. table.
bacteremia/sepsis?
Strep. pneumonia
hemophilus influenza type B
infections in sickle cell. table.
meninigitis?
Strep. pneumonia
what is upper airway?
nasal cavity, pharynx, larynx
what is lower airway?
trachea, primary bronchi, lungs
bronchial carcinoid. epidemiology?
Most common lung cancer in adolescents/young adults
Neuroendocrine tumor derived from bronchial Kulchitsky cells
bronchial carcinoid. manifestation?
proximal airway obstruction (dyspnea, wheezing, cough)
Recurrent pneumonia distal to obstruction
Hemoptysis
Carcinoid syndrome is less common than with midgut carcinoid
bronchial carcinoid. diagnosis?
chest imaging - contrast enhanced (vascular) tumor with endobronchial component
bronchoscopy with biopsy
BRONCHOGENIC CARCINOMA VS MESOTHELIOMA IN ASBESTOSIS. smoking relations?
Bronchogenic carcinoma is more common, especially in smokers
BRONCHOGENIC CARCINOMA VS MESOTHELIOMA IN ASBESTOSIS.
pleural mesothelioma presents as? 2
a. Unilateral pleural abnormality
b. Moderate-to-severe ascites
BRONCHOGENIC CARCINOMA VS MESOTHELIOMA IN ASBESTOSIS. nieko
Note: Pleural plaques are consistent with asbestosis but not particularly with either bronchogenic carcinoma or mesothelioma. Plaques may be seen in both of these malignancies but that is because of asbestosis, not the malignancies themselves.
