Hola amigos, he revisado las visitas a los casos de tórax y veo que son menos que al Diploma. Intuyo que los casos no son lo bastante interesantes. Espero que este nuevo caso lo sea y aumente la participación. ¡Recordad que las respuestas son anónimas!
Se trata de una mujer de 47 años con febrícula y un infiltrado pulmonar izquierdo, que no ha variado apreciablemente en los últimos seis meses.
¿Cuál sería vuestro diagnóstico?
1. Tuberculosis
2. Carcinoma
3. Neumonía tórpida
4. Nada de lo expuesto
Podéis dar vuestra opinión hasta el viernes, día en que se publicará la solución.
Haz click aquí para ver la respuesta
Hallazgos: las radiografías de tórax muestran enfermedad alveolar segmentaria en lóbulo superior izquierdo (flecha) y también en base izquierda.
El TAC torácico confirma la afectación alveolar, con un obvio broncograma aéreo (flechas rojas). La apariencia del broncograma aéreo es la típica del “árbol sin hojas”, en la que los bronquios son estrechos y poco ramificados (ver Dr. Pepe’s Diploma nº 62). Este aspecto es altamente sugerente de un proceso neoplásico que infiltra el espacio alveolar y comprime los bronquios, tales como el adenocarcinoma o el linfoma.
Diagnóstico definitivo: adenocarcinoma, confirmado con biopsia
Radiografías de control un año más tarde muestran la progresión de la enfermedad.
Felicidades a Mónica, que hizo el diagnóstico correcto y una discusión inteligente.
Bien, martes por la tarde y ningún comentario todavía. Creo que vamos a batir un nuevo record!
Bueno, voy a lanzarme. Yo me quedo con adenocarcinoma pulmonar mucinoso. Existe una condensacion en el LSI, con areas perifericas de infiltrado en vidrio deslustrado y nódulos pulmonares. La condensacion creo que presenta relativa baja atenuación apreciandose el signo del angiograma y el del “árbol sin hojas” (bonquios abiertos en su interior con escasas ramificaciones). También creo que existen adenopatias mediastinicas.
Yessssss!!
Al fin alguien que contesta y encima lo hace bien!
There are some signs of loss of volume, consolidation spreads as satellite nodules to adjacent segments. Small airways seem to be affected as well in spite of the air bronchogram. The lymphadenopathy is not exactly expressed. Such a slow course, 6 months? (no change in the x-rays or CT exactly?)
I agree with Monica, we can’t say there is no bronchoalveolar carcinoma here.
What about BALT lymphoma?
I would also think about an expression of organising pneumonia. Mycobacterium – other than TB as well? (would expect some rough (also clinical) course in case of usual TB).
I would say that a “leafless tree” appearance of the bronchi is highly suggestive of malignancy. Chronic pneumonias usually have dilated bronchi.
There was no obvious change in the radiographs, which is not unusual in adenocarcinomas.
se aprecia un patrón alveolar, consolidación con broncograma aéreo y vidrio esmerilado que compromete el lóbulo superior izquierdo. Cancer. Muy buenos los casos y el marco teórico que enriquece aun mas el conocimiento. Soy estudiante de Neumonologia y me resulta de gran utilidad la información presentada luego de cada caso!!! Saludos
Gracias. Me alegra saber que estos casos sirven para algo. El punto a conservar de este caso es que los broncogramas tipo “árbol sin hojas” son altamente sugerentes de neoplasia.
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