Los casos de Dr. Pepe – Caso de tórax 4 (Resuelto)

ESP_torax_case_final_4

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.

CT

Lateral tórax

PA tórax

Haz click aquí para ver la respuesta

24
Nov 2014
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DISCUSSION 83 Comments

83 Responses to : Los casos de Dr. Pepe – Caso de tórax 4 (Resuelto)

  1. Dr. Pepe says:

    Bien, martes por la tarde y ningún comentario todavía. Creo que vamos a batir un nuevo record!

  2. Monica says:

    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.

  3. Ele says:

    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).

    • Dr.Pepe says:

      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.

  4. Paula van kerckhoven says:

    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

    • Dr.Pepe says:

      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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