Hola amigos, os presento el segundo caso de tórax. La radiografía PA corresponde a un hombre de 40 años con dolor e hinchazón del tobillo derecho, acompañado de fiebre. Cuál sería vuestro diagnóstico?
1. Adenocarcinoma diseminado
2. Sarcoidosis
3. Neumonía vírica
4. Nada de lo expuesto
Podéis enviar vuestra opinión hasta el viernes, en que se dará la solución.
Haz click aquí para ver la respuesta
La radiografía simple muestra múltiples opacidades pulmonares que en algunas zonas aparecen como nódulos (círculos). Algunos de estos nódulos muestran cavitación en su interior. Estos hallazgos son confirmados en la TC, donde aparecen nódulos sólidos (flecha amarilla) y nódulos cavitados (flecha naranja).
Hallazgos:
El diagnóstico diferencial debe incluir todas las entidades que cursen con opacidades nodulares: procesos inflamatorios (vasculitis), neoplasias metastásicas o primarias (adenocarcinoma bien diferenciado), enfermedad granulomatosa (sarcoidosis, Tbc) o enfermedad infecciosa. Dado que el paciente presenta clínicamente un cuadro de infección con diseminación hematógena, y presenta un foco que puede producir trombosis venosa por contigüidad, el embolismo pulmonar séptico es el diagnóstico mas probable.
Diagnóstico final: embolias sépticas por osteomielitis de tobillo.
Veo que no hay ninguna respuesta! A partir de ahoa, a los tres primer@s que contesten les enviaré una foto del Dr. Pepe
Me lanzaré a dar el primer diagnóstico. Se ven múltiples opacidades nodulares bilaterales, algunas de ellas por ejemplo en LSD parecen cavitadas, creo que podría ser embolismos sépticos del foco que tiene en el tobillo.
Enviaré foto próximo viernes. He de pasar por lan peluquería primero
…considerando el infiltrado bilateral y un foco inflamatorio en otra región me inclinaría a pensar en Sarcoidosis….aunque me gustaría apoyar mi sospecha en alguna a departía medistinal que no logro visualizar. Espero la respuesta….y la foto del Dr Pepe.
Fe de erratas: ” me gustaría apoyar mi sospecha en alguna adenopatia mediastinal “
Respuesta y foto el viernes. Yo pensaría que la cavitación va en contra de sarcoidosis.
Muchas Gracias!!
Estimado profesor
El paciente tiene un cateter venoso central. Ademas se identifican multiples nodulos pulmonares , algunos cavitados.
Pudieran tratarse de embolos septicos o de una endocarditis.
Enviaré foto. Gracias por pnarticipar
Estimado Alberto, tu dirección de mail ha desaparecido del servidor y no puedo enviarte la foto. Puedes enviar un nuevo comentario? Gracias
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