Clinical features :1- cough dry or productive
2-Haemoptysis
3-Chest pain
4-Dyspnea
5-Pleural effusion
6-Anorexia & loss of weight
7-Clubbing of the fingers
8-Hoarseness of the voice (recurrent LN)
9-Dysphagia involvement of the esophagus
10-Hormonal syndromes ..ectopic ACTH , ADH, hypercalcaemia ,carcinoid
syndrome
Diagnosis
Clinical , sputum cytology
Chest X-ray ,CT chest ..
Bronchoscopy ,BAL ,bronchial brush &biopsy
FNAC….or Trucut biopsy , pleural fluid aspiration & cytology
Diagnostic Thoracoscopy & mediastinoscopy
TNM classification for staging
Signs of inoperability :1-Bloody pleural effusion .positive for
malignant cells
2-Horner’s syndrome .
3-Vocal cord paralysis
4-Phrenic nerve palsy(elevated hemi
diaphragm)
5-SVC obstruction
6-Distant metastasis
7-If during surgery ,the tumor locally
spreading or cannot be remover
technically or fixed to the PA or to the
heart ,it is technically irresectable
Treatment
1-Surgery more than 50%of the patients have distant metastases
at the time of diagnosis .
50% Iresectable per operatively
15-20 % resectability rate
Surgery ..segmentecomy , lobectomy . pneumectomy
2-Radiotherapy
Pre operative or post operative
Chemo therapy vincristine or adriamycin
Bleomycin for malignant effusion
Differential diagnosis of a solitary lung lesion (COIN LESION)
1-Hydatid cyst
4- Primary benign lesion
2-Tuberculoma
5-primary malignancy of the lung
3-Angiomatous malformation (AV fistula) 6-metastatic tumors
Pulmonary Echinococcosis (Hydatid Cyst)
Hydatid disease of the lung is caused by the
.small. tape worm (Echinococcus Granulosus)
Hydatid cyst means cyst full of water .It has a life
cycle between dogs & sheep .Parasites in the
elementary tract of the dog shed ova that
excreted in the dog faeces , contaminated the
food of the sheep in which hydatid cyst will
develops in the viscera . Including the lung
.Infected sheep when slaughtered and its entrails
are eaten by dogs , the life cycle is completed
.When a human being hands or food become
contaminated with canine fecal material
containing ova which will be ingested .The
parasitic larva burrow through the gastric mucosa
and are carried to the liver in the portal venous
circulation where most of them filtered out to
form hydatid cyst of the liver , some escape the
liver & lodge in the lung to form one or more
hydatid cyst which grows slowly or rapidly over
years .
The cyst consists of a germinal layer & cyst fluid containing broad capsule &
scoleses . A cellular white hyaline layers are laid down outside the cyst so that
the cyst is enclosed by a laminated cyst membrane .As the cyst enlarged , it
usually reaches the pleural surface . Compression of the lung tissues produces a
thin fibrous layer of atelectatic lung tissue around the cyst (capsule , pericyst or
adventia)
Clinical Manifestation
A-Asymptomatic
Any smooth homogenous opacity of uniform density with clear cut border and
little or no reaction around it on a chest X-Ray is a hydatid cyst unless proved
the other wise .
B-Cough & haemoptysis due to rupture of the cyst , or it can lead to severe
dyspnea , or asphyxia ,or a hyper sensitivity reaction ,
If the cyst get infected ,it will lead to formation of lung abscess or bronchiectatic
changes .
Radiological Findings
1-Smooth homogenous opacity (Intact H.C).
2-Partial rupture
(peri-vesicular pneumocyst).
3-Complete rupture
(Water –lilly sign) .
4-Formation of lung abscess(Air –fluid level) .
5-Completely coughed out cyst(empty cavity )
6-Rupture into the pleura (hydropneumothorax) •
Treatment
Surgical
A-Inoculation means to remove it intact.
B-Aspiration &evacuation technique
C-Wedge resection or excision of the cyst with adjacent lung tissue.
D-Segmentectomy ,Lobectomy or Pneumonectomy (rare ).