Hola amigos, el Dr. Pepe me ha dejado plantado y se ha ido a las Bahamas con Miss Piggy. Mientras tanto, he de hacer su trabajo. He escogido las radiografías de control anual de un hombre de 76 años operado de carcinoma de vejiga hace cinco años. ¿Véis alguna anormalidad?
Podéis dar vuestra opinión hasta el viernes, día en el que se publicará la solución.
Haz click aquí para ver la respuesta
Hallazgos: en la radiografía PA se observa un pequeño nódulo subclavicular derecho (A,B flechas), que pasó desapercibido. Un año más tarde el nódulo ha aumentado considerablemente de tamaño (C, flecha). El diagnóstico más probable es un carcinoma primario de pulmón, que se asocia a tumores vesicales o, menos probable por su aspecto, una metástasis. El paciente fue operado y el nódulo resultó ser un melanoma.
Diagnóstico final: melanoma de pulmón con metástasis a ganglios del cuello.
Felicidades al Dr. Chalo y al Dr. Carly, que encontraron la lesión.
Teaching point: entre el 25% y 50% de los nódulos en vértices (tamaño medio 1,6 cm) no se reconocen inicialmente. Es muy importante mirar cuidadosamente los vértices pulmonares para evitar cometer este error.
Estamos a miércoles y aún nadie contesta?
Os daré una ayuda: a qué se asocia el carcinoma de vejiga?
Imagen nodular apical derecha
nódulo apical derecho
añado que el nódulo me parece cavitado con lo cual probablemente el paciente tenía un carcinoma escamoso de vejiga.
Mi diagnóstico final: metástasis de carcinoma escamoso de vejiga.
Spine metastasis
Me parece observar un tenue opacidad nodular en la topografía del lóbulo superior derecho….
Correcto!
Al uso de inmunoterapia con BCG, lo cual puede ser la causa de ese fino patrón miliar
Lo siento. Lo correcto ibe dirigido a Dr. Chalo
Correcto!
Nódulo apical derecho con foco radiotransparente q podría ser por cavitación.
Muy buen caso
Gracias. Vendrán más y mejores (espero).
¿Estará también asociado a la presencia de aire subdiafragmatico derecho?.
Creo que el aire subdiafragmatico derecho es el colon
Si. es un síndrome de Chilaiditi. No tiene relación on el otro hallazgo
Q te parece mi respuesta de arriba dr. Pepe? Estoy impaciente jeje
Has visto el nódulo, que es lo importante (no lo vieron inicialmente). Fué un melanoma, con gran sorpresa de todos.
Creo que deberías acudir a un hospital de nivel superior para un diagnóstico y tratamiento oportuno.
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Muy interesante el caso, especialmente la dificultad para identificar el nódulo en los vértices pulmonares. Es un recordatorio importante de la necesidad de un examen minucioso en las radiografías de tórax.
¡Interesante caso! Me pregunto qué anormalidades podrían aparecer.
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