Hola amigos: El caso de hoy corresponde a un hombre de 58 años con dolor en hemitórax derecho.
Podéis dar vuestra opinión hasta el viernes, día en el que se publicará la solución.
Hallazgos: La radiografía localizada muestra una lesión extrapulmonar (A, flecha) con destrucción de la costilla subyacente (A, asterisco). En la radiografía lateral se observa una amputación parcial del húmero izquierdo (B, flecha roja), rodeado por el muñón de tejidos blandos (B, flechas):
Diagnóstico: Metástasis costal de fibrosarcoma de húmero izquierdo (intervenido).
El objetivo de esta presentación es discutir lesiones periféricas extrapulmonares. Dichas lesiones se caracterizan por tener unos bordes bien definidos y ángulos obtusos en su periferia. Se diferencian de las lesiones intrapulmonares periféricas porque éstas presentan ángulos agudos (Fig. 1).
Fig. 1A: Aspecto típico de una lesión extrapulmonar con bordes bien delimitados y ángulos obtusos (A, flechas). B: La imagen muestra una lesión con ángulos agudos (B, flecha) y, por consiguiente, intrapulmonar.
Las lesiones extrapulmonares periféricas pueden originarse en la pleura o en la pared torácica. Aquellas que proceden de la costilla pueden descubrirse fácilmente en la radiografía de tórax si identificamos la lesión costal. Ello nos permite sugerir un diagnóstico de malignidad. Las dos causas más frecuentes de masas con efectación costal in adultos son las metástasis y el mieloma (Fig. 2):
Fig. 2: Varón de 45 años con dolor en hemitórax izquierdo. La radiografía PA muestra una lesión periférica extrapulmonar (A, flecha), apenas visible en la proyección lateral (B).
La radiografía localizada muestra que la costilla subyacente no es visible (C, asterisco). Un TC axial muestra una gran lesión destructiva costal con masa de partes blandas (D, flecha). Biopsia demostró una metástasis de hepatocarcinoma.
Si no se observa lesión costal en la radiografía, es preciso hacer un TC para determinar la densidad de la lesión. Las más frecuentes son tejidos blandos o grasa.
La densidad de tejidos blandos identifica una lesión sólida tumoral, que habrá que investigar. Las etiologías más frecuentes son los tumores fibrosos de pleura, neurofibromas y metástasis (Fig. 3):
Fig. 3: Típica lesión extrapulmonar en un paciente operado de timoma maligno (A, flecha). No se ven alteraciones costales. TC muestra una lesión pleural sólida (B, flecha), que correspondía a una metástasis pleural del timoma.
Los lipomas de pared torácica no son infrecuentes. No pueden distinguirse en la radiografía convencional de tumores sólidos, ya que tienen una densidad similar. Son fácilmente demostrables por TC, que evidencia la densidad grasa y confirma la inocuidad de la lesión (Figs. 4-5 ):
Fig. 4: Varón de 52 años asintomático, en el que se descubrió accidentalmente una lesión extrapulmonar (A, flecha). TC demuestra que la lesión corresponde a grasa parietal (B, flecha).
Fig. 5: Varón de 57 años con carcinoma broncogénico. La radiografía PA de tórax muestra un hilio tumoral (A, flecha) y una lesión extrapulmonar (A, flecha roja). TC confirma un colapso parcial de LII (B, flecha). La masa visible en la placa PA corresponde a grasa parietal (C, flecha roja) y por tanto, carece de significado.
El líquido pleural encapsulado puede dar también lesiones extrapulmonares. No suele dar problemas diagnósticos, ya que la evolución clínica suele ser suficiente. En caso de duda, un TC confirma la densidad agua del líquido (Fig. 6):
Fig. 6: Varón de 35 años con empiema encapsulado. La radiografía PA muestra una colección extrapulmonar (A, flechas) con densidad líquida en el TC coronal (B, flechas). Como en la gran mayoría de líquido encapsulado pleural hay pinzamiento del seno costofrénico.
El consejo de Dr. Pepe:
- El signo de la embarazada diferencia las lesiones extrapulmonares de las pulmonares periféricas.
- La destrucción de la costilla subyacente apunta a una lesión maligna.
- La TC nos permite identificar lesiones sólidas y excluye la grasa extrapleural, que carece de significado patológico.
opacity of the apex of the right lung
parietal mass
Tumor pleural
Imagen compatible con lesión pleural compatible con derrame pleural lo cuñado va mesotelioma
La costilla está destruída, lo que sugiere en primer lugar una lesión costal con masa acompañante.
Más información mañana.
Buen fin de semana!
Mesotelioma
metástasis.
Esta lesion fue resecada quiurgicamente?
LESIÓN EXTRA PLEURAL , LA LESION PUEDE SER UNA OSTEOLISIS COSTAL.
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Built-in DApp Browser: The wallet includes a decentralized application (DApp) browser that allows users to interact with various DeFi platforms, such as decentralized exchanges (DEXs), lending platforms, and NFT marketplaces, directly within the wallet.
TronLink is available as a browser extension for Chrome, Firefox, and Edge, and also has mobile versions for iOS and Android.
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Infinity Wallet is more than just a typical wallet. It offers a range of features that sets it apart from the competition. With robust security features and user-friendly design, it provides users with the ability to manage multiple digital assets all in one place.The digital age has brought about the need for more secure, efficient, and easy-to-use wallets. Enter the Infinity Wallet Extension, a cutting-edge solution designed to meet the demands of modern users. Whether you’re a crypto enthusiast or someone who just wants a seamless digital wallet, Infinity Wallet has something for everyone.
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Discover Phantom Wallet Extension, the ultimate solution for managing your crypto assets effortlessly. This secure and user-friendly browser extension allows you to store, send, and receive cryptocurrencies with ease. Enjoy seamless integration with decentralized applications (dApps) on the Solana blockchain, enabling smooth transactions and enhanced features. With Phantom Wallet, you can track your portfolio, access DeFi platforms, and explore NFTs—all in one place. Elevate your crypto experience today!
Phantom Extension is a secure and user-friendly browser extension designed for managing your crypto assets on the Solana blockchain. Effortlessly store, send, and receive cryptocurrencies while exploring decentralized applications (dApps) and NFT marketplaces. With its intuitive interface, you can track your portfolio, access DeFi platforms, and make transactions seamlessly. Whether you’re a beginner or a seasoned pro, Phantom Extension enhances your crypto experience, making it easy to manage and interact with digital assets.
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The evening desert safari is a journey into the Arabian Desert, featuring adrenaline-pumping dune bashing, sandboarding, and camel rides. End the day with a sumptuous dinner, mesmerizing traditional performances, and a peaceful desert night under the stars.Experience the thrill of an evening desert safari with exhilarating activities like dune bashing. with live entertainment and stargazing under the desert sky.
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Dubai Desert Safari is a must-do adventure that offers a blend of thrill, culture, and natural beauty. It typically includes an exhilarating dune bashing experience in a 4×4 vehicle across the rolling sands of Dubai’s vast desert, followed by activities like sandboarding, camel rides, and quad biking.
The Morning Desert Safari provides a shorter, yet equally exciting experience. Start your day with an adrenaline-pumping dune bashing session, followed by activities like sandboarding and camel riding.
Capital One Login is a secure online portal that allows Capital One customers to access their bank accounts, credit cards, and financial services. Users can manage transactions, pay bills, view statements, and monitor account activity through the website or mobile app. It offers features like multi-factor authentication to ensure security and protect user data.
DLF Camellias Gurgaon assimilates stunning architecture, breathtaking landscape design and the learning from DLF’s best developments across India to deliver a living experience far superior to anything experienced to date. GOLF DRIVE.
The Binance Wallet Extension is a secure and user-friendly browser extension designed to simplify the management of cryptocurrencies directly from your web browser. It enables users to store, manage, and transfer cryptocurrencies, as well as interact with decentralized applications (dApps) on various blockchain networks. As an extension of the Binance ecosystem, it integrates seamlessly with the Binance exchange, making it an ideal tool for traders and crypto enthusiasts who seek convenience and security.
Cryptocurrency security is a top priority for anyone invested in digital assets. As the industry grows, so does the need for secure methods of storage, with hardware wallets like Trezor leading the charge. In this guide, we’ll walk you through everything you need to know about getting started with Trezor, accessing its full functionality through trezor.io/start, and ensuring the safety of your assets.
DLF Camellias in Gurgaon is a luxury residential development known for its ultra-premium apartments and penthouses. Located in DLF Phase 5, on Golf Course Road, it offers a blend of exclusivity, world-class amenities, and architectural elegance.
DLF Lux 5 is an ultra-luxurious residential project located in the prestigious DLF Phase 5 on Golf Course Road, Gurgaon. this development blends world-class amenities with modern architecture and serene landscapes.
Coinbase.com is a leading cryptocurrency platform that allows users to buy, sell, and manage digital currencies like Bitcoin, Ethereum, and more. With a user-friendly interface, secure storage, and educational resources, Coinbase simplifies crypto trading for beginners and experts alike.
The Coinbase Extension provides quick and secure access to your crypto wallet directly from your browser. Manage digital assets, track prices, and explore decentralized apps (dApps) with ease. The extension supports a wide range of cryptocurrencies and integrates seamlessly with the Coinbase platform, offering a user-friendly experience for both beginners and advanced users.
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To redeem your Apple Gift Card, simply open the App Store, Apple Music, or Apple TV app on your device. Scroll to the bottom of the screen and tap on your account icon, then select the “Redeem Gift Card or Code” option. You can either manually enter the 16-digit code printed on the back of the card or use your device’s camera to scan the code for quick redemption. Alternatively, if you’re redeeming through your Apple ID account settings, you can navigate to “Settings,” tap on your name, select Payment & Shipping, and choose Redeem Gift Card or Code. Once entered, the value of your gift card will be added to your Apple account balance, which can be used toward purchasing apps, games, subscriptions, or even hardware from the Apple Store. The process is quick, secure, and allows you to start enjoying your Apple purchases immediately. If you encounter any issues or need further assistance, Apple’s support team is readily available to help you with your redemption.
To check your Nike gift card balance, simply visit the Nike website or open the Nike app. Enter your 16-digit gift card number and PIN in the “Check Balance” section to instantly view your remaining balance. You can also check your balance in-store by showing your card to a Nike associate. Nike gift cards never expire and can be used both online and in Nike stores. If you have any issues or need assistance, Nike’s customer support is ready to help!
Uniswap V3 is the latest version of the popular decentralized exchange (DEX) that allows users to trade cryptocurrencies directly from their wallets. It introduces key innovations like concentrated liquidity, enabling liquidity providers (LPs) to allocate their capital more efficiently by choosing specific price ranges for their assets. This increases capital efficiency and allows LPs to earn higher returns on their investments. Uniswap V3 also offers multiple fee tiers, giving traders more flexibility in choosing the optimal cost for their transactions. With enhanced features like better slippage control and improved scalability, Uniswap V3 aims to make decentralized trading faster, cheaper, and more efficient.
Raydium is a decentralized exchange (DEX) built on the Solana blockchain, offering fast and low-cost trading of cryptocurrencies. It leverages the high-speed, low-latency capabilities of Solana to provide seamless trades with minimal fees. Raydium also acts as an automated market maker (AMM) and liquidity provider, integrating with Serum’s central limit order book to offer deeper liquidity and better price discovery. By combining the benefits of both AMM and order book models, Raydium delivers efficient trading for users while enabling liquidity providers to earn rewards. With its fast transactions and scalable ecosystem, Raydium is a key player in the Solana DeFi space.
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