Download - Bronchogenic carcinoma
Bronchogenic carcinoma
Dr / Hytham Nafady
Pathology
Symptoms of local chest disease:• Cough.• Hemoptysis.
Symptoms of chest wall invasion:• Chest pain.
Symptoms of mediastinal invasion:• e.g. superior vena cava syndrome (dilated anterior chest wall veins).
Symptoms of distant metastases:
Constitutional symptoms:• Weight loss.• Malaise.• Weakness.
Paraneoplastic syndromes:
CP
Causes of hemoptysis
Paraneoplastic syndromes
• Migratory thrombophlebitis.• Cerebellar degeneration.• Eaton Lambert syndrome.• Hypertrophic osteoarthropathy.• Hypocalcemia (ectopic PTH).• Hypercalcemia (ectopic cacitonin).• Ectopic ACTH• SIADH
Radiological manifestations of BC
1. Hilar enlargement & increased density.
2. Bronchial obstruction.
3. Pulmonary mass lesion.
4. Pulmonary nodule.
5. Mediastinal involvement.
6. Pleural effusion.
7. Chest wall involvement.
8. Bone involvement.
9. Metastases.
Hilar enlargement
Normal hilum
Contents of the hilum
Contents of the hilum
Bronchi Bronchi Pulmonary arteriesPulmonary arteries Pulmonary veinsPulmonary veins Lymph NodesLymph Nodes
DD of hilar enlargement
DD of hilar lymphadenopathy
Pulmonary plethora
• Infant with VSD.
• Cardiomegagly , prominent pulmonary conus & Pulmonary plethora are suggestive of left to right shunt
Pulmonary hypertension
• Prominent main pulmonary artery segment (MPA), which appears to be aneurysmally dilated.
• Right pulmonary artery (RPA) is also enlarged. • Enlargement of right pulmonary artery differentiates it from the post
stenotic dilatation of main pulmonary artery in pulmonary stenosis. • In post stenotic dilatation, even though the left pulmonary artery which is
in line with the main pulmonary artery may be dilated, the right pulmonary artery which does not have the effect of the jet and eddy currents, is not dilated.
• This X-ray also shows a prominent right atrial contour, indicating right atrial dilatation as a consequence of pulmonary hypertension and right ventricular hypertrophy.
• The end on views of blood vessels seen through the right pulmonary artery shadow are tiny, indicating that the RPA dilatation is unlikely to be due to increased pulmonary blood flow. Large end on vessels are a feature of pulmonary hypertension due to excessive left to right shunt causing increased pulmonary blood flow. In this case, the absence of them would make one think that the severe pulmonary hypertension is probably primary.
• The right ventricular systolic pressure and hence the pulmonary artery systolic pressure estimated by continuous wave Doppler interrogation of the tricuspid regurgitation jet was over 110 mm Hg.
Bronchial obstruction
Bronchial tapering
Bronchial cut off sign
Bronchial cut off sign
Bronchial cut off
Endobronchial mass
Effects of bronchial obstruction
Obstructive collapse
2ry pneumonia
Criteria of 2ry pneumonia:1. Consolidation collapse.2. Consolidation with no air bronchogram.3. Consolidation with hilar mass.4. Consolidation confined to one lobe for
more than 2 weeks without resolution or spread to other lobes.
5. Unresolved pneumonia (for more than 8 weeks after proper antibiotic therapy).
Golden S sign
Golden S sign
Bronchocele (mucoid impaction)
• Branching tubular opacities giving finger in glove appearance.
Pulmonary mass lesion
> 3 cm.
Pulmonary nodule Criteria of malignancy
Size Large pulmonary nodule (>2cm).Enlarging (doubling time 1-18 months)
Margin Spiculated.Lobultated.Poorly defined.
Calcification Usually no calcification.Stippled or eccentric calcification (engulfment of calcified granuloma).
Cavitation Thick walled eccentric cavitation with irregular inner margin.
Air bronchogram
Broncho-alveolar carcinoma.
• Corona radiata sign• Fine linear strands
extending 4-5 mm outward
• Spiculated on CXRs• 84 – 90% are
malignant
Spiculated margin
• Corona radiata sign• Fine linear strands
extending 4-5 mm outward
• Spiculated on CXRs• 84 – 90% are
malignant
Spiculated margin
• Scalloped border• Intermediate
probability of cancer• Smooth border
suggestive of benign diagnosis
Lobulated margin
• Scalloped border• Intermediate
probability of cancer• Smooth border
suggestive of benign diagnosis
Lobulated margin
Illdefined margin
Air bronchogram
Calcification
Mediastinal involvement
• Mediastinal lymph node enlargement.
• Involvement of mediastinal structures.
Mediastinal LN enlargement
Upper right paratracheal LN:
Convexity of the SVC interface.Thickening of the right paratracheal strip.
Lower right paratracheal:
Enlargement of the azygos arch.
Upper left paratracheal LN:
Convexity of the left subclavian artery interface.
Aorto-pulmonary LN:
Convexity of the aorto-pulmonary window.
Subcarinal LN: Convexity of the superior extent of azygo-esophageal recess.
Widening of the carina.
Paraoesophageal LN:
Thickening of the posterior tracheal band on lateral film.
Mediastinal lymph node metastases
Esophagus Esophageal compression or invasion.
Phrenic nerve Diaphragmatic paralysis
Recurrent laryngeal N. Vocal cord paralysis.
SVC Dilated neck & anterior chest wall veins.
Pulmonary artery Pulmonary oligemia.
Pericardium Pericardial effusion.
Pulmonary vein Tumoral thrombosis
Bronchogenic carcinoma with tumoral thrombosis of the left superior pulmonary vein
Phrenic nerve palsy
Phrenic nerve palsy
SVC syndrome
SVC obstruction
Azygos arch
Bronchogenic carcinoma with invasion of the intrapericardial portion of the left pulmonary
artery
Pleural effusion
Pathology:
• Direct spread.
• Lymphatic obstruction.
• 2ry pneumonia.
Radiolgical criteria:
Pleural effusion without mediastinal shift due to underlying obstructive collapse
Chest wall invasion C.P:Focal chest pain.Radiological manifestations:CXR:Bone destruction.Chest wall mass.CT:Area of contact >Obtuse angleMRI:• Parietal tumoral signal intensity on T1 (T2 WIs has no value)• Parietal enhancement.• Interruption of the extrapleural fat.In superior sulcus tumor:• Invasion of the subclavian vessels.• Invasion of the brachial plexus.
Bone involvement
Direct bone invasion.• Rib or vertebral body destruction.Hematogenous metastases:• Usually osteolytic metastases.Hypertrophic osteoarthropathy:• Involving the wrist, hand, ankle & foot.• The involved bone show solid periosteal
reaction.
Metastases LLBB: Lung, liver, bone & brain.Adrenal gland.
BAC
Thank you