imaging: cervicothoracic sign & canon ball masses
TRANSCRIPT
Imaging of the week
65 yr old female ,presented with neck swelling –3 months loss of appetite,weight – 3 months no other significant symptoms
O/E PR -86/mt BP- 120/80 mm hg CVS,RS,ABD.,CNS.,--NAD
CXR –PA VIEW WELL CENTRED INSPIRATORY FILM ADEQUATELY PENETRATEDTRACHEA –SHIFTED TO LT.HOMOGENOUS OPACITY –RT.NECK AND RT.APEX i.e, ‘CERVICOTHORACIC SIGN’ NODULAR OPACITIES- WELL DEFINED MULTIPLE
,RANDOMLY DISTRIBUTEDi.e, ‘CANNON BALL’ MASSESELEVATED RT.HEMIDIAPHRAGM
“Cervico thoracic sign” -due to neck mass extending into superior mediastinum or the other way round
-most common causes thymoma teratoma thyroid tumors lymphoma
CT FINDINGS
HOMOGENOUS OPACITY PRESENT IN THE SUPERIOR MEDIASTINUM -RIGHT SIDE
NODULAR OPACITIES- WELL DEFINED MULTIPLE ,RANDOMLY DISTRIBUTED MORE AT THE BASE
IMPRESSION THYROID SWELLING EXTENDING INTO
THE SUPERIOR MEDIASTINUM
MULTIPLE METASTASES INVOLVING BOTH
LUNG FIELDS
RIGHT DIAPHRAGMATIC PALSY
PATTERNS OF SECONDARIES LUNG
A:PARENCHYMAL NODULES -SOLITARY - MULTIPLE - ‘CANNON BALL’ MASSES
B:INTERSTITIAL THICKENING -LYMPHANGITIC CARCINOMATOSIS
C:PULMONARY HYPERTENSION & INFARCTION
D:PLEURAL EFFUSION
“Cannon ball masses”
-tumor emboli deposited in the interstitium -equal restriction of growth on all sides by alveoli - leading to well defined circular masses
Differential diagnosis for multiple nodular opacities A; Tumors -benign-hamartomas -malignant –lymphomas ,secondaries B;Vascular lesions - thromboemboli /septic emboli with organised infarcts C;Collagen vascular diseases -wegener’s ,rhematoid nodules D;Inflammatory granulomas - fungal,bacterial,parasites ,sarcoidosis
Tumours causing secondaries lung kidney thyroid colorectum breast liver head and neck melanoma prostate uterus,cervix sarcomas
t h a n k y o u