CHEST AND MEDIASTINU
LUNGS
BRONCHOGENIC CARCINOMA
DESCRIPTION:
LUNG CANCER IS ANY OF THE VARIOUS PRIMARY MALIGNANT NEOPLASMS
THAT MAY APPEAR IN THE LUNG. LUNG CANCER IS THE LEADING CAUSE OF
DEATH FROM CANCER IN BOTH MEN AND WOMEN.
Etiology: The exact cause of lung cancer is unknown; however inhalation of carcinogens is
known to be a predisposing cause. Cigarette smoking is by from the most important risk factor
for the development of carcinoma of the lung.
Epidemiology: Lung cancer is rarely found in the individuals under the age of 40 years. The
incidence rate rises rapidly after the age of 50 years, 60 years being the average age of
occurrence. The majority of cases appear between 50 and 75 years of age. The occurrence ratio is
2:1 male to female.
Sign and Symptoms: Patients may present with any combination of the following: cough,
haemoptysis, dyspnea, pneumonia , chest pain, shoulder pain, arm pain, bone pain, hoarseness
headaches, seizures or swelling of face or neck.
Imaging Characteristics: Chest x-ray is usually done first although there is some debate
regarding spiral CT for screening of lung cancer.
CT
 Appears as a mass with irregular speculated margins.
 There maybe central necrosis with large tumors.
 CT is good for staging of lung cancer ( i.e.metastatic mediastinal lymph nodes, liver and
adrenal metastasis).
Treatment: Surgery, radiation therapy and chemotherapy maybe used pending on the staging
and type of cancer.
PROGNOSIS: Depending on the stage of the cancer , the 5 year survival rates varies from just
greater than 50 percent for patients with stage I disease to approximately 15 percent for those
with stage III disease,
BULLOUS EMPHYSEMA
Description:
Emphysema is one of the many chronic obstructive pulmonary disease affecting the lungs. This
reduces the surface area for the gas exchange anfd allows the collection of free air on inhalation
to accumulate in the lung tissue.
Etiology:
Cigarette smoking is the most common cause associated with the development of this disease. In
a rare form of emphysema, a congenital deficiency in the production of the protein antitrypsin is
associated to wth the development of emphysema I young adults.
Epidemiology:
It is estimated that more than 60,000 deaths per year are related to emphysema. It usually occurs
after the fourth decade of life and is more commonly seen in males.
IMAGING CHARACTERISTICS:
CT
 Hyperinflation of the lungs.
 Lucent, hypodense (dark) areas of the lung surrounded by normal lung parenchyma.
These hypodense sharply demarcated areas measuring 1cm or greater in diameter are
commonly referred to us blebs or bullae and represent the collection of “free air” trapped
within the lung during the breathing (inhalation) process and unable to be exhaled.
Treatment:
Smoking cessation, administration of oxygen and eating a well-balanced diet are common
methods of treatment. Lung reduction surgery maybe indicated in select cases.
PROGNOSIS:
Depends on the extent of the disease, however an improved prognosis is expected if the patient
quits smoking,eats a balanced diet, and uses supplemental oxygen.
PULMONARY METASTATIC DISEASE
Description:
the kung is frequently the site of metastatic disease from primary cancers outside the lung.
Metastatic spread to the lung is usually considered to be incurable. A solitary pulmonary lesion
may represent a metastasis process or a new primary lung cancer.
Etiology:
the lungs are the most frequent site of metastatic spread. Metastatic spread is accomplished
through the blood circulation or lymnphatic system.
Epidemiology:
Carcinoma of the kidney, breast, pancreas,colon and uterus are most likely to metastasized to the
lungs.
Signs and Symptoms:
The most common symptom is a cough. Other related symptoms include hemoptysis, wheezing,
fever,dyspnea, and chest pain.
Imaging Characteristics:
CT is the modality of choice for imaging pulmonary metastatic disease.
CT
 Typically shows multiple bilateral lungs masses that are noncalcified.
 May also shows mediastinal lymphadenopathy.
Treatment: Surgical resection possible. Radiation therapy maybe used when tumors are
inoperable, and chemotherapy for palliative use.
Prognosis: Poor
PULMONARY EMBOLI
Description: A pulmonary embolus (PE) is an obstruction of the pulmonary artery or one of its
branches by an embolus.
Etilogy: Generally results from dislodged thrombi originating in the leg viens. Risk factors
include long term immobility, chronic pulmonary disease, congestive heart failure, recent
surgery, advanced age, pregnancy, fractures of surgery to the lower extremities, burns, obesity,
malignancy and use of oral contraceptives.
Epidemiology: This is the most common pulmonary complication in hospital patients. The
incidence rate of new cases is between 600,000 and 700,000 annually with 100,000 to 200,000
deaths. Men and women are equally affected. Advancing age increases risk of developing
pulmonary emboli.
Signs and Symptoms: Chest pain, shortness of breath, haemoptysis (coughing of blood) and
swelling of legs.
Imaging Characteristics: Spiral CT pulmonary angiography (CTPA) is the best non-invasive
test for diagnosing PE and is gradually replacing the ventilation/perfusion (V/Q) lung scan. CT is
reliable in diagnosing emboli enlarger central pulmonary arteries but may miss small emboli in
smaller sub segmental peripheral pulmonary arteries which may not be clinically significant.
PERINEPHRIC HEMATOMA
Description: A perinephric hematoma is a collection of blood that is confined to Gerota fascia
(i.e., perirenal fascia) and arises as a result of blunt or penetrating trauma to the kidney.
Etiology: Blunt or penetrating trauma to the abdominal area.
Epidemiology: Renal injuries occur in approximately 10 percent of trauma victims. Most renal
injuries are associated with motor vehicle accidents. It is common for a haemorrhage to occur in
the perinephrotic space following a renal biopsy.
Sign and Symptoms: Depending on the extent of the injury and time to treatment, patients may
present with abdominal pain, an open wound, signs of internal bleeding with blood in the urine ,
increased heart rate , declining blood pressure, and hypovolemic shock ,nausea and vomiting,
decrease alertness , and moist clammy skin.
Imaging Characteristics: Contrast-enhanced CT is the modality of choice for the evaluation of
abdominal or renal trauma.
CT:
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Hyperdense in appearance on acute noncontrast studies.
HYpodense area surrounding the contrast-enhanced kidney.
Shows associated laceration of kidney.
Follow up CT for stable patient with conservative treatment to monitor resolution of
hematoma.
Treatement: Surgical intervention may be required in emergent situations for the
hemodynamically unstable patient. Conservative treatment for the stable patient may include bed
rest, analgesics and patient monitoring.
Prognosis: Depends on the extent of the injury, patient’s response to treatment, and any other
associated injuries.