Imaging: Multiple Pulmonary Cavitary Lesions
Upcoming SlideShare
Loading in...5
×
 

Like this? Share it with your network

Share

Imaging: Multiple Pulmonary Cavitary Lesions

on

  • 2,026 views

 

Statistics

Views

Total Views
2,026
Views on SlideShare
2,026
Embed Views
0

Actions

Likes
0
Downloads
32
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Imaging: Multiple Pulmonary Cavitary Lesions Presentation Transcript

  • 1.  
  • 2.
    • Mr.rajan
    • 38 yr old smoker
    • C/O swelling all over the body - past 4 months
    • 5months back-he developed
    • Cough-productive,scant mucoid sputum
    • chest pain-diffuse pricking increases with cough
    • Breathlessness-Class iii(NO orthopnoea/PND)
    • No chest pain/palpitation
    • No haemoptysis/fever
    • No oliguria/dysuria/haematuria
  • 3. On Examination
    • Pt conscious oriented
    • Afebrile
    • No pallor /icterus / cyanosis/clubbing
    • B/L pitting pedal edema
    • Not dyspnoeic
    • No generalised lymphadenopathy
    • JVP not elevated
    • PR 86/min BP 110/70mm Hg
  • 4.  
  • 5.  
  • 6.  
  • 7.  
  • 8.  
  • 9.  
  • 10.  
  • 11.  
  • 12.
    • INFECTIVE CAUSES
    • mycobacterial –
    • Bacterial-
    • staph aureus,klebsiella,psuedomonas,nocardiosis, anaerobes
    • Fungal-
    • aspergillus,blastomycosis,coccioidomycosis, histoplasmosis
    • Septic emboli
    • Lung abscess
    DIFFERENTIALS FOR MULTIPLE CAVITARY LESIONS
  • 13.
    • TRAUMA
    • Pulmonary contusion
    • Septic emboli
    • Lung abscess
    • GRANULOMATOUS, INFLAMMATORY DISORDERS
    • Necrotizing sarcoid granulomatosis/lung
    • Wegeners granulomatosis
    • COLLAGEN VASCULAR DISORDERS
    • Polyarteritis nodosa
    • Rheumatoid lung disease
    • VASCULAR DISORDERS
    • Pulmonary infarction with cavitation
    • NEOPLASTIC DISORDERS
    • Lymphomas
    • Metastatic lung disease
    • carcinoma of lung
  • 14. LOOKING AT CAVITIES
    • What is the anatomic distribution?
      • Is It single or multiple?
      • If multiple , are they focally located or diffusely seen in multiple lobes of both lungs?
    • Is are the characteristics of the cavity?
      • Is the cavity wall thick or thin?
      • Is the interior lining nodular, shaggy, or smooth?
    • Are there any other associated radiographic abnormalities?
  • 15. INVESTIGATIONS
    • Urine routine-protein 2+, 3-5 RBCs
    • TC 13800
    • DC P66 L 32 E2
    • ESR 56mm/hr
    • Platlets 1,45,000
    • Hb 12.8 g
    • Urea -17 mg
    • Creatinine 0.8 mg
  • 16.
    • HIV – NR
    • SPUTUM AFB negative
    • Sputum c/s no growth
    • RF – neg
    • ANA – Neg
    • CRP elevated
    • ENT OPINION : Polyp from Lt middle meatus, VLS-normal
  • 17. FNAC OF A NODULE(CT GUIDED)
  • 18.  
  • 19. POSSIBILITIES
    • 1.WEGENER’S GRANULOMATOSIS
    • 2.PULMONARY LANGERHANS CELL HISTIOCYTOSIS
  • 20. P-ANCA … POSITIVE Approximately 90% of patients with active Wegener’s granulomatosis have a positive antiproteinase-3 ANCA. A small percentage of patients with Wegener’s granulomatosis may have antimyeloperoxidase rather than antiproteinase-3 antibodies.
  • 21. Points in favour
    • Renal involvement
    • P-ANCA positivity
    • Radiolgical features
    • Paranasal sinus involvement
  • 22. Wegener granulomatosis
    • Granulomatous, necrotizing, small & medium vessel vasculitis
    • Any age (40-55 yrs.)
    • Frequency of 3 per 100,000 persons
    • TRIAD
    • RENAL -Microscopic hematuria, proteinuria, and rapidly progressive RF
    • UPPER AIRWAYS- recurrent / nonresolving sinusitis, epistaxis, nasal septal perforation (saddle nose deformity)
    • LOWER AIRWAY- subglottic stenosis. Single or multiple cavitating/noncavitating Pulmonary nodules or diffuse alveolar hemorrhage
  • 23. Wegener granulomatosis
    • Skin rash, migratory arthritis
    • Ocular involvement (scleritis, corneal ulceration,orbital dis.)
    • Mononeuritis multiplex or CNS involvement with or without pachymeningitis
    • ANCA (180pt., 96%with severe dis.,83%with limited dis.)
    • Lung biopsy yield 91% of cases
    • Upper airway biopsy yield only 21%of cases
    • Renal biopsy:focal, segmental necrotizing, crescentic glomerulonephritis with few to no immune complexes
  • 24. ANCA
    • ANCA plays a central role
    • Antibodies directed against certain cytoplasmic proteins in neutrophils and monocytes
    • Two major categories based on IF– C & P ANCA
    • Present in high percentage in systemic vasculitis
  • 25. Kallenberg CGM et al. (2006) Mechanisms of Disease: pathogenesis and treatment of ANCA-associated vasculitides Nat Clin Pract Rheumatol 2: 661 – 670 doi:10.1038/ ncprheum0355 Figure 1 Cytoplasmic components of ethanol-fixed neutrophils, stained by indirect immunofluorescence, in a serum sample from a patient with active Wegener's granulomatosis and antineutrophil cytoplasmic autoantibodies to proteinase 3
  • 26. RENO-PULMONARY SYNDROMES
    • 1.ANTI-GBM ANTIBODIES: Goodpasture’s syndrome
    • 2.ANCA-POSITIVE VASCULITIS
    • Wegener’s granulomatosis
    • Microscopic polyangiitis
    • Churg–Strauss syndrome
    • 3.ANCA-NEGATIVE VASCULITIS
    • Henoch–Schönlein purpura
    • Mixed cryoglobulinaemia
    • Behçet’s disease
    • IgA nephropathy
    • 4.INFECTIONS
    • 5.DRUGS
    • Propylthiouracil
    • D-Penicillamine
    • Hydralazine
    • Allopurinol
    • 6.RHEUMATIC DISEASES
    • (immune complexes)
    • Systemic lupus erythematosus
    • Scleroderma
    • Polymyositis
    • Rheumatoid arthritis
    • Mixed collagen vascular disease
  • 27.