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Bronchogenic carcinoma


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Bronchogenic carcinoma

  1. 1. Bronchogenic carcinoma Dr / Hytham Nafady
  2. 2. Pathology
  3. 3. 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
  4. 4. Causes of hemoptysis
  5. 5. Paraneoplastic syndromes • Migratory thrombophlebitis. • Cerebellar degeneration. • Eaton Lambert syndrome. • Hypertrophic osteoarthropathy. • Hypocalcemia (ectopic PTH). • Hypercalcemia (ectopic cacitonin). • Ectopic ACTH • SIADH
  6. 6. 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.
  7. 7. Hilar enlargement
  8. 8. Normal hilum
  9. 9. Contents of the hilum Contents of the hilum BronchiBronchi Pulmonary arteriesPulmonary arteries Pulmonary veinsPulmonary veins Lymph NodesLymph Nodes
  10. 10. DD of hilar enlargement
  11. 11. DD of hilar lymphadenopathy
  12. 12. Pulmonary plethora • Infant with VSD. • Cardiomegagly , prominent pulmonary conus & Pulmonary plethora are suggestive of left to right shunt
  13. 13. Pulmonary hypertension
  14. 14. • 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.
  15. 15. Bronchial obstruction
  16. 16. Bronchial tapering
  17. 17. Bronchial cut off sign
  18. 18. Bronchial cut off sign
  19. 19. Bronchial cut off
  20. 20. Endobronchial mass
  21. 21. Effects of bronchial obstruction
  22. 22. Obstructive collapse
  23. 23. 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).
  24. 24. Golden S sign
  25. 25. Golden S sign
  26. 26. Bronchocele (mucoid impaction) • Branching tubular opacities giving finger in glove appearance.
  27. 27. Pulmonary mass lesion > 3 cm.
  28. 28. 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.
  29. 29. • Corona radiata sign • Fine linear strands extending 4-5 mm outward • Spiculated on CXRs • 84 – 90% are malignant Spiculated margin
  30. 30. • Corona radiata sign • Fine linear strands extending 4-5 mm outward • Spiculated on CXRs • 84 – 90% are malignant Spiculated margin
  31. 31. • Scalloped border • Intermediate probability of cancer • Smooth border suggestive of benign diagnosis Lobulated margin
  32. 32. • Scalloped border • Intermediate probability of cancer • Smooth border suggestive of benign diagnosis Lobulated margin
  33. 33. Illdefined margin
  34. 34. Air bronchogram
  35. 35. Calcification
  36. 36. Mediastinal involvement • Mediastinal lymph node enlargement. • Involvement of mediastinal structures.
  37. 37. 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.
  38. 38. Mediastinal lymph node metastases
  39. 39. 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
  40. 40. Bronchogenic carcinoma with tumoral thrombosis of the left superior pulmonary vein
  41. 41. Phrenic nerve palsy
  42. 42. Phrenic nerve palsy
  43. 43. SVC syndrome
  44. 44. SVC obstruction Azygos arch
  45. 45. Bronchogenic carcinoma with invasion of the intrapericardial portion of the left pulmonary artery
  46. 46. Pleural effusion Pathology: • Direct spread. • Lymphatic obstruction. • 2ry pneumonia. Radiolgical criteria: Pleural effusion without mediastinal shift due to underlying obstructive collapse
  47. 47. Chest wall invasion C.P: Focal chest pain. Radiological manifestations: CXR: Bone destruction. Chest wall mass. CT: Area of contact > Obtuse angle MRI: • 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.
  48. 48. 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.
  49. 49. Metastases LLBB: Lung, liver, bone & brain. Adrenal gland.
  50. 50. BAC
  51. 51. Thank you