Hola amigos, os presento un nuevo caso de tórax. Las imágenes son de un pakistaní de 29 años con dolor torácico desde hace dos meses. ¿Cuál sería vuestro diagnóstico?
1. Tumor de pared
2. Absceso tuberculoso
3. Tumor fibroso de pleura
4. Nada de lo expuesto
Podéis dejar vuestra opinión hasta el viernes, día en que se dará la solución.
Haz click aquí para ver la respuesta
Hallazgos: Las radiografías de tórax muestran una discreta elevación del hemidiafragma derecho, que presenta un bulto en su porción anterior (Fig 1B, flecha roja). Hay líquido libre pleural (Fig 1B, flecha). El TAC axial y sagital muestra una masa sólida en la pared anterior torácica (Fig 2, flechas). La masa es claramente parietal, lo que excluye el tumor fibroso pleural, que raramente invade la pared. Su densidad es de tejidos blandos, lo que también excluye el absceso tuberculoso, que es de densidad líquida. El PET-TAC muestra una marcada captación de la masa (Fig 3).
Fig 1
Fig 2
Fig 3
Con estos hallazgos, el diagnóstico más probable es el de tumor de pared. En una persona joven sin afectación costal, la primera consideración es un sarcoma de tejidos blandos.
Diagnóstico: PNET (peripheral neuroectodermal tumor).
Felicidades a Paula van Kerckhoven y Héctor por su diagnóstico.
Tumor de la pared
Le quieres poner un apellido?
Tumor de pared.DD; Sarcoma,rabdomiosarcoma
Estimado profesor.
Pudiera tratarse de un abceso de pared frio por Tuberculosis.
Ademas se acompaña de liquido pleural.
A mi me suena a carcinomatosis peritoneal. En un joven yo miraria los testiculos porque el cancer de testiculo es el mas frecuente en esa edad. Le haria una ecografia testicular y un TC de abdomen. Puede ser?
Imagino que podría ocurrir; pero no sería mi primer diagnóstico.
Los testículos estaban bien clínicamente y el TAC abdominal sin alteraciones.
Gracias dr Caceres. Entonces un tumor de celulas pequenas o una infeccion de las que atraviesan la pleura y la pared como una actinomicosis. El linfoma puede dar masas de partes blandas sin mucha lesion osea como este parece tener.El camino mas corto biopsiar guiado por eco y cultivar.
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