Hola amigos, hoy os quiero presentar las radiografías de un hombre de 50 años con anemia.
¿Cuál sería vuestro diagnóstico?
1. Granuloma TB
2. Carcinoma
3. Hamartoma
4. Nada de lo expuesto
Podéis dar vuestra opinión hasta el viernes, día en el que se publicará la solución.
Haz click aquí para ver la respuesta
Hallazgos: La radiografía PA muestra una opacidad ovoide en base derecha (A, flecha) no visible claramente en la placa lateral (B). La clave del diagnóstico yace en la imagen localizada, que muestra un vaso de gran calibre cercano a la opacidad (C, flecha). Ello sugiere una vena de drenaje y una posible malformación arterio-venosa.
El examen del paciente descubrió hallazgos compatibles con enfermedad de Randu-Weber-Osler. Imágenes de TAC coronal y axial confirman la fístula AV izquierda (D, flechas) y una segunda malformación paramediastínica derecha (E, flecha).
Diagnóstico final: Malformación arterio-venosa en enfermedad de Randu-Weber-Osler.
Teaching point: La mayoría de las lesiones nodulares presentan un aspecto inespecífico. Descubrir un vaso hipertrofiado en su vecindad puede ayudar a sugerir una malformación arterio-venosa, con confirmación posterior por TAC.
Puede se un hamartoma pero le faltan calcificaciones
La frecuencia de calcificación visible en hamartoma es del 5% en placa simple y 20% en CT.
Por consiguiente, la falta de calcio en este caso no excluye hamartoma.
Gracias por participar.
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Por la anemia pienso que es cáncer
Gracias Dr Pepe
Profesor:
Por la anemia podria tratarse de una hematopoyesis extramedular
Si asumimos que la lesión es intrapulmonar ( lo parece) podemos descartar la hematopoyesis extramedular, que aparecería como una masa mediastínica.
El caso es difícil. La imagen localizada ayuda a ver más cosas.
Gracias por participar.
Parece un nódulo-massa pulmonar, en el lòbul inferior Izquierdo, de màrgenes bien definidos, però con probable broncograma aereo en su interior. Puede corresponder a una condensación pulmonar de morfologia nodular vs neoplasia bronquiolo-alveolar. Además los hilios pulmonares en la Rx lateral me parecen aumentados de tamaño y densos, podrian correspondre a adenopaties aunque en la Rx PA no visualizo correctamente los hilios pulmonares.
Estoy de acuerdo en que la radiografía lateral es equívoca y sugiere adenopatías; pero no fueron demostradas en el TAC.
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Hola amigos, hoy os quiero presentar las radiografías de un hombre de 50 años con anemia.
¿Cuál sería vuestro diagnóstico?
Los hallazgos radiográficos típicos (lesión pulmonar con calcificaciones en “palomitas de maíz”) son característicos de un hamartoma pulmonar, un tumor benigno.
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Fascinating case! Always interesting to see how thoracic imaging leads to clear diagnosis. Great work, Dr. Pepe!
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Fascinating case! The subtle yet telling clue of the hypertrophied vessel beside the lesion was brilliantly highlighted
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A mí me parece un hamartoma (opción 3) por el aspecto de la lesión; gracias por compartirlo.
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This is a really interesting case, Dr. Pepe! I like how you ask for opinions. It makes me think about what it could be. The anemia part makes it tricky, but I’m excited to see the answer on Friday!
Thanks for sharing!!
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Hello friends, today I want to show you the X-rays of a 50-year-old man with anemia.
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gracias por compartir este interesante caso de tórax, siempre es un buen ejercicio para mantener vigente el diagnóstico por imagen. por cierto, ¿alguien conoce cookie clicker 2 para matar el tiempo mientras espero la próxima entrega de casos?
gracias por compartir este interesante caso de tórax, siempre aprendo mucho de los casos clínicos del dr. pepe. ¡excelente recurso para mantenernos actualizados en diagnóstico por imagen!
Me llamó la atención que el caso fuera de un hombre de 50 años con anemia, porque eso abre bastante el diagnóstico diferencial antes de ver la solución. Además, la forma en que planteaste las opciones —granuloma TB, carcinoma, hamartoma o “nada de lo expuesto”— invita a pensar bien la radiografía y no irse a la respuesta más obvia.
¡Excelente caso, Dr. Pepe! Me encantó el desafío diagnóstico de este paciente de 50 años con anemia. Aunque las opciones entre granuloma TB, carcinoma y hamartoma son todas plausibles, la presentación radiográfica me inclina más hacia el hamartoma. Espero con ansias la solución del viernes para confirmar si acerté.
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La ausencia de calcificaciones no descarta el hamartoma: este caso demuestra cómo una radiografía bien leída puede convertir una pista mínima en un diagnóstico certero.
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