Hola amigos, Hoy os presento imágenes de un hombre de 48 años operado de un carcinoide de ileon terminal.
¿Cuál sería vuestro diagnóstico?
1. Granulomas
2. Metástasis
3. Amiloidosis
4. Nada de lo expuesto
Podéis dejar vuestro comentario hasta el viernes, día en el que se dará la solución.
Haz click aquí para ver la respuesta
Hallazgos: La radiografía PA muestra nódulos calcificados que aparentemente están en el pulmón (A, flechas). En la placa lateral los nódulos son anteriores, lo que sugiere que pueden estar pegados a la pared torácica (B, flechas). También se observa calcio en el hemidiafragma derecho (A, flecha roja):
El TC demuestra que los nódulos corresponden a placas pleurales localizadas en la pared anterior del tórax, simulando nódulos pulmonares en la radiografía convencional (C,D, flechas). También se observan placas calcificadas en el diafragma (E, flechas):
Diagnóstico final: Placas pleurales calcificadas secundarias a la exposición a asbestos.
METASTASIS
No te parece raro que estén todas agrupadas delante?
Gracias por participar!
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«Interesante caso clínico. Por la descripción del paciente y la localización del carcinoide, mi sospecha se inclina hacia metástasis, aunque no puedo descartarlo sin más información. Sería útil conocer la apariencia macroscópica y los hallazgos histológicos para confirmar el diagnóstico. Espero la solución del viernes para comparar.»
calcified pulmonary nodules (“egg shells”): amyloidosis is a possibility
Aside from other considerations (see answer today) follow Confucius : “always think of a rare manifestation of a common disease rather than a common manifestation of a rare disease”
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Hola Este tipo de casos siempre despierta mucho interés, especialmente cuando se trata de un paciente con antecedentes de carcinoide en el íleon terminal. Es fundamental tener en cuenta la historia clínica completa para llegar a un diagnóstico acertado.
En cuanto a las opciones, los granulomas podrían ser una posibilidad, pero las metástasis también son una consideración importante en pacientes con antecedentes de tumores. La amiloidosis, aunque menos común, es algo que nunca hay que descartar completamente. Estoy curioso por ver la solución final el viernes, ¡seguro que será una enseñanza interesante!
Gracias por compartir este caso, ¡espero leer las respuestas de todos
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This is a fascinating case! Based on the limited information and the patient’s age, my initial thought leans towards metastasis. The fact that it’s a terminal ileon carcinoid raises that suspicion. It would be interesting to see the histology to rule out the other options. Speaking of finely controlled slides, the precision and control in diagnosing are almost like the precision needed to nail a perfect drift in Drift Hunters! Really curious to see the final diagnosis.
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Okay, wow, seeing that scan actually made my stomach clench a bit. I’m leaning towards metastasis, sadly. Those nodules… they just have that unsettling look. But honestly, option 4, “nada de lo expuesto,” keeps nagging at me. You know, sometimes you see something and it just…feels off, like trying to navigate life after a Flappy Bird high score (or low score, more likely!). It messes with your perception. I’m intrigued to see the actual answer – hope the patient is doing okay!
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Interesantísimo caso. A primera vista me inclino por metástasis, aunque admito que las imágenes siempre tienen algún detalle que te hace dudar un poco. Curioso ver cómo se resuelven estos hallazgos. ¡A la espera del viernes!
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Interesting case: in a 48-year-old patient with a history of terminal ileum carcinoid surgery, the chest images raise strong suspicion for metastasis in the differential diagnosis.
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Este caso clínico es muy interesante y la discusión sobre las posibles metástasis es intrigante. Me gustaría saber más sobre los hallazgos específicos que llevaron a la solución final.
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Me sorprende que el paciente tenga 48 años y un carcinoide de ileon terminal
In a patient with a history of carcinoid tumor, the most likely diagnosis is metastases, though confirmation requires proper imaging and clinical correlation.
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Caso muy bien planteado, Dr. Pepe. La observación sobre el patrón es clave para el diagnóstico diferencial. Muchas gracias por compartir.