ABSTRACT
La linfangitis carcinomatosa es un trastorno relativamente poco común caracterizado por la infiltración difusa de los vasos linfáticos pulmonares por cáncer metastásico. Es una manifestación tardía que implica mal pronóstico. El diagnóstico puede ser difícil y requiere de un alto índice de sospecha. La embolia pulmonar tumoral es la presencia de múltiples acúmulos de células tumorales en las pequeñas arterias, arteriolas y capilares septales del pulmón. La oclusión de la microvasculatura pulmonar por células tumorales y trombos asociados puede producir una entidad clínica subaguda y progresiva que se asemeja a la enfermedad tromboembólica . Algunas modalidades de imágenes pueden ayudar a definir el diagnóstico, especialmente gammagrafía pulmonar de ventilación-perfusión y su característico patrón de múltiples defectos de perfusión sub- segmentarios periféricos sin alteraciones ventilatorias o en la angiografía. El tratamiento no ha sido ampliamente estudiado, ya que el diagnóstico por lo general no se realiza hasta después de la muerte. Se realiza una revisión de la literatura sobre la evaluación y el diagnóstico de estas dos entidades clínicas poco frecuentes.
Lymphangitic carcinomatosis is a relatively uncommon disorder characterized by diffuse infiltration of the pulmonary lymphatics by metastatic cancer. It is a late manifestation of malignancy that implies bad prognosis. The diagnosis can be difficult and requires a high degree of suspicion. Microscopic pulmonary tumor embolism is the presence of multiple aggregates of tumor cells in the small pulmonary arteries, arterioles and septal capillaries. Occlusion of the pulmonary microvasculature by tumor cells and associated thrombi can produce a subacute and progressive clinical entity that resembles thromboembolic disease. Some imaging studies may help to define the diagnosis, especially the ventilation-perfusion lung scan and its typical pattern of multiple peripheral sub-segmental perfusion defects without ventilatory abnormalities or the angiography. Treatment for this entity has not been extensively studied, since the diagnosis is usually made postmortem. We provide a review of the literature about the evaluation and diagnosis of these two infrequent clinical entities.
Subject(s)
Pulmonary Embolism , Lymph Nodes , LymphangitisABSTRACT
La esporotricosis es una infección micótica de evolución subaguda o crónica que puede afectar a humanos y animales, la cual está caracterizada por presentar lesiones nodulares cutáneas y subcutáneas, su incidencia varia en las distintas regiones de sudamerica. Se presenta el caso de un paciente varón de 28 años de edad con el diagnóstico de esporotricosis linfangítica, que tardó alrededor de tres meses en ser diagnosticado; se realiza un análisis y seguimiento de la evolución haciendo especial mención en los aspectos clínicos, diagnósticos y terapéuticos de esta enfermedad con la finalidad de alertar un diagnóstico precoz y tratamiento oportuno.
The esporotricosis is a mycotic infection of subacute or chronic evolution that can concern human beings and animáis, which is characterized for presenting nodular cutaneous and subcutaneous injuries, its incidente is different regions of sudamerica. There appears the case of a 28-year-old patient male of age with the diagnosis of esporotricosis linfangítica, that was late about three month in being diagnosed; there is realized an analysis and follow-up of the evolution doing special mention on the clinical, diagnostic and therapeutic aspects of this disease with the purpose of real a precocious diagnosis and opportune treatment.
Subject(s)
SporotrichosisABSTRACT
PURPOSE: Our purpose was to evaluate F-18 FDG uptake in pulmonary lymphangitic carcinomatosis (PLC) according to CT findings and histology of lung cancer. Materials and METHODS: Thirty-three lung cancer patients with PLC were enrolled in this retrospective study. All the patients had a CT-based diagnosis of PLC. Chest CT findings of PLC were classified on the basis of involvement of axial interstitium. We categorized the involvement of axial interstitium as group 1, and the involvement of peripheral interstitium only as group 2. Visual and semiquantitative analyses by F-18 FDG PET/CT were performed in the PLC lesions. At first, we analyzed the F-18 FDG uptake in the PLC by visual assessment. If abnormal uptake was seen in the PLC, we drew regions of interest in the PLC lesions to obtain the maximum SUVs (maxSUVs). RESULTS: Of the 33 patients, 22 had abnormal F-18 FDG uptake in the visual assessment. There was no significant difference in the frequency of abnormal F-18 FDG uptake between group 1 and group 2 (p=0.17), although the frequency of group 1 tended to be higher than group 2 (15/19 (78.9%) in group 1, 7/14 (50.0%) in group 2). However, group 1 had a higher maxSUV than group 2 (p<0.01, group 1: 2.9+/-1.4, group 2: 1.5+/-0.6). There was no significant difference in the frequency of abnormal F-18 FDG uptake and maxSUV among the histology of the lung cancers. CONCLUSION: The involvement of axial interstitium in the PLC by lung cancer has a higher maxSUV than the involvement of only peripheral interstitium.
Subject(s)
Humans , Carcinoma , Lung , Lung Diseases, Interstitial , Lung Neoplasms , Retrospective Studies , ThoraxABSTRACT
Objective To study the imaging findings of pulmonary lymphangitic carcinomatosis (PLC) and discuss it′s clinical value. Methods The imaging materials of 40 cases with PLC which were proved by bronchoscopic or pleural or open-lung biopsy were retrospectively analyzed, and the clinical application of imaging diagnosis were investigated. Results The primary tumorous pathological types of PLC included:13 cases peripheral type carcinoma of lung,2 cases central type carcinoma of lung,11 cases mammary cancer,6 cases gastric carcinoma,4 cases pancreatic carcinoma,3 cases renal carcinoma,1 case colon carcinoma. The major imaging features of PLC were showed as pleural nodes, lobular core nodes, intralobular small reticular and nodular shadows, small beaded thickened interlobular septums, beaded thickened bronchovascular bundles, tumescent pulmonary hilar and/or mediastinal lymph nodes. Conclusion PLC possess relative imaging feature, particularly HRCT may accurately reflect pathological feature of PLC. Imaging diagnosis is a satisfactory method in diagnosing pulmonary lymphangial metastasis of malignant tumor.
ABSTRACT
A 52-year-old woman was presented with 2-week history of increasing dyspnea and dry cough. The chest radiograph revealed bilateral reticular infiltrates. Radiographic infiltrates were rapidly progressed and symptoms from hypoxemia were aggravated. The patient was intubated and bronchoscopy with transbronchial lung biopsies was performed. Biopsies revealed lymphatic vessels plugged by nests of metastatic adenocarcinoma. She died 11 days after admission despite of intensive ventilatory support. We had difficulties in the diagnosis of lymphangitic lung carcinomatosis at initial presentation of her illness because the progression was unusually rapid. Lymphangitic lung carcinomatosis should be included in the differential diagnosis of patients showing rapidly progressive interstitial radiographic findings. Also, transbronchial lung biopsy may be a useful tool to confirm the diagnosis.