RSNA读片会病例挑战3肺结

TomásFranquet,MDPhD

ChiefPulmonaryRadiology,HospitaldeSantPau(UniversidadAutónomadeBarcelona)

?MD:UniversidaddeNavarra,Pamplona

?ResidencyandPhD:ClinicaUniversidaddeNavarra

?Fellowship:thoracicradiology(NestorL.Müller)Vancouver

Expertise/researchcontributions:ChestCT;thoracicinfections

ImagingFindings

?CXR:Ill-definedmassintheLLLextendingfromthelefthilum.

?ContrastenhancedCT:Homogeneousnon-cavitarysoft-tissuemasswithlefthilaradenopathy,displacementofbroncho-vascularstructuresandareasofperipheralcollapse

?PET-CT:Intensehomogenousincreasedglucoseuptakeofthemassandincreasedabnormalglucoseuptakeinleftlowerparatracheal,subcarinalnodalstationandlefthilum(thanreactiveuptake)

DifferentialDiagnosis

Solitarylungmasswithlymphadenopathies:manypossibilities

1.Neoplastic:Lungcancer(invasiveADK,undifferentiatedneuroendocrinetumor(carcinoid),Maltoma,…

2.Inflammatory/Granulomatous:Sarcoidosis,IgG4disease,GPA,Bronchocentricgranulomatosis…

3.Infectious:Mycobacteria,Fungi

ImagingFindings

CT:Multiplesmallnodulesinperi-lymphaticdistribution,subpleural,alongthebronchovascularbundles,interlobularseptumandinasymmetricandupperzonepredominantdistribution

DifferentialDiagnosis

Neoplastic:

1.Lymphangitiscarcinomatosa:ADK(breast,lung,stomach)

2.Lymphoproliferativedisease

3.Pulmonarytumorthromboticmicroangiopathy(PTTM):Gastriccanceristhemost







































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