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| {{CMG}} {{AE}} {{Trusha}} | | {{CMG}} {{AE}} {{Trusha}} |
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| | ==new== |
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| | {| align="right" |
| | | |
| | [[Image:Squamous cell mircopathology2.jpeg|x200px|thumb| Micropathology: Squamous cell carcinoma of the lung. H&E stain, By Nephron [https://commons.wikimedia.org/wiki/File%3ALung_squamous_carcinoma_--_high_mag.jpg Wikimedia Commons]]] |
| | |} |
| | {| align="right" |
| | | |
| | [[Image:Bronchial cancer.jpeg|x200px|thumb|Gross pathology: Bronchial squamous lung cell cancer By John Hayman [Public domain], (Image source: [https://commons.wikimedia.org/wiki/File%3ACa_bronchus.jpg Wikimedia Commons])]] |
| | |} |
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| {| | | {| |
| |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
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| ! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
| |
| | colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
| |
| ! colspan="6" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
| |
| | colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
| |
| ! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
| |
| |-
| |
| | colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
| |
| ! colspan="2" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam
| |
| |-
| |
| ! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
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| ! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Radiology
| |
| ! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
| |
| |-
| |
| ! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Productive cough
| |
| ! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hemoptysis
| |
| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Weight loss
| |
| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
| |
| ! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Percussion
| |
| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Auscultation
| |
| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CBC
| |
| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sputum analysis
| |
| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Nodule
| |
| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Nodule content
| |
| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other findings
| |
| |-
| |
| | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pulmonary nodule|Pulmonary Nodule]](benign)
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
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| | style="background: #F5F5F5; padding: 5px;" |
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| * Asymptomatic
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| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Hyporesonance
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| * Dull percussion
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| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Normal
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|
| |
|
| * Present [[pleural friction rub]]
| |
| * Present [[egophony]]
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| * Crackling or bubbling noises
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| * Present whispered pectoriloquy
| |
| * Decreased/absent [[breath sounds]]
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Normal
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| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Normal
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| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Single
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| * Round, oval
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| * <5 mm nodule
| |
| * Ground glass
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| | style="background: #F5F5F5; padding: 5px;" |Fat in nodule
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|
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|
| Calcification
| | # [[Superior vena cava obstruction]] |
| * Central dense nidus
| | # [[Partial anomalous pulmonary venous connection]] |
| * Diffuse solid
| | # [[Esophageal achalasia]] |
| * Laminated
| | # [[Esophageal cancer]] |
| * Popcorn
| | # [[Esophageal rupture]] |
| | style="background: #F5F5F5; padding: 5px;" |
| | # [[Hiatus hernia]] |
| * well-defined smooth border
| | # [[Hilar lymphadenopathy]] |
| * Growth rate over 18 months
| | # [[Pneumomediastinum]] |
| * Cavity wall thickness of 1 mm
| | # [[Sarcoidosis]] |
| | style="background: #F5F5F5; padding: 5px;" |
| | # [[Lymphoma]] |
| * N/A
| | # [[Neurilemmoma]] |
| | style="background: #F5F5F5; padding: 5px;" |N/A
| | # [[Non-Hodgkin lymphoma]] |
| | style="background: #F5F5F5; padding: 5px;" |↓ O2 Sat
| | # [[Teratoma]] |
| |-
| | # [[Thymoma]] |
| | style="background: #DCDCDC; padding: 5px; text-align: center;" |Pulmonary Nodule (malignant)
| | |
| | style="background: #F5F5F5; padding: 5px;" | ++
| | # [[Thyroid cancer]] |
| | style="background: #F5F5F5; padding: 5px;" | ++
| | # [[Goitre]] |
| | style="background: #F5F5F5; padding: 5px;" | ++
| | # [[Mediastinal germ cell tumor]], |
| | style="background: #F5F5F5; padding: 5px;" |
| | # [[Mediastinal tumor]], |
| * [[Dyspnea]]
| | # [[Mediastinitis]] |
| * Non resolving [[pneumonia]]
| | |
| * [[Wheeze|Wheezing]]
| | # [[Churg-Strauss syndrome]] |
| * [[Chest pain]]
| | # [[Bronchogenic cyst]], |
| * [[Cachexia]]
| | # [[Dermoid cyst]] |
| * [[Fatigue]]
| | # [[Anthrax]]: |
| * [[Anorexia|Loss of appetite]]
| | # [[Tularemia]] |
| * [[Dysphonia]]
| | |
| * [[Dysphagia]]
| | |
| | style="background: #F5F5F5; padding: 5px;" | | | [[File:Mediastinal lymohangioma GIF.gif|x200px|thumb| CT scan shows cystic mass which was located on the posterior to the lower esophagus later diagnosed as thoracic duct lymphangioma. [https://doi.org/10.5090/kjtcs.2014.47.4.423 Source:Case courtesy of Jin San Bok et al, Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital]]] |
| * Hyporesonance
| | |
| * Dull percussion
| | |
| | style="background: #F5F5F5; padding: 5px;" | | | [[File:Posterior-mediastinal-schwannoma.gif|x200px|thumb| CT scan showing a soft tissue density lesion within the left posterior mediastinum, in a paravertebral location. The lesion is closely related to the left neural exit foramen, but there is no definite extension into the spinal canal. The lesion does extend into the intercostal space. |
| * Normal
| | Case courtesy of Dr Paul Leong |
| | (Picture courtesy:[https://radiopaedia.org/cases/26625 Radiopedia])]] |
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|
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|
| * Present [[pleural friction rub]]
| | __NOTOC__ |
| * Present [[egophony]]
| | {{SI}} |
| * Crackling or bubbling noises
| | {{CMG}}; {{AE}} {{Trusha}}, {{AM}} |
| * Present whispered pectoriloquy
| |
| * Decreased/absent [[breath sounds]]
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Normal
| |
| | style="background: #F5F5F5; padding: 5px;" |'''Sputum cytology'''
| |
| * Tumor cells
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Multiple small
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| * Single > 2 cm of size
| |
| | style="background: #F5F5F5; padding: 5px;" |Calcification
| |
| * Amorphous
| |
| * Punctate
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| * Reticular
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| * Stippled or eccentric
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| Cavity
| |
|
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|
| Ulceration
| | {{SK}} Mediastinal enlargement; mass in the mediastinum |
| *
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Spiculated border
| |
| * Rapid growth rate (Doubling time 1-18 months)
| |
| * Cavity wall thickness over 15 mm
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * central necrosis
| |
| * Cavity lined by viable cancer cells without necrosis
| |
| *
| |
| | style="background: #F5F5F5; padding: 5px;" |Biopsy and histopathological analysis
| |
| |↓ O2 Sat
| |
| |-
| |
| | style="background: #DCDCDC; padding: 5px; text-align: center;" |
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| | style="background: #F5F5F5; padding: 5px;" |
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| | style="background: #F5F5F5; padding: 5px;" |
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| | style="background: #F5F5F5; padding: 5px;" |
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| | style="background: #F5F5F5; padding: 5px;" |
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| *
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| | style="background: #F5F5F5; padding: 5px;" |
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| | style="background: #F5F5F5; padding: 5px;" |
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| *
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| | style="background: #F5F5F5; padding: 5px;" |
| |
| |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
| |
| !Diseases
| |
| ! colspan="1" rowspan="1" |Cough/Sputum
| |
| ! colspan="1" rowspan="1" |Hemoptysis
| |
| !Weight loss
| |
| !Other symptoms
| |
| ! colspan="1" rowspan="1" |Percussion
| |
| !Auscultation
| |
| !CBC
| |
| !Sputum analysis
| |
| !Nodule
| |
| !Content
| |
| !Other findings
| |
| !Histopathology
| |
| |'''Gold standard'''
| |
| !Additional findings
| |
| |-
| |
| | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lung abscess|Abscess]]
| |
| | style="background: #F5F5F5; padding: 5px;" | ++
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * High fever
| |
| (> 101' F)
| |
| * [[Pleuritic chest pain|Pleuritic]] [[chest pain]]
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Dull percussion
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Decreased [[Breath sounds|breath sound]]
| |
| * Bronchial [[Breath sounds|breath sound]]
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| * [[Crackles|Inspiratory crackles]]
| |
| * [[Crepitations|Localised crepitations]]
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| ** Pronounced [[leukocytosis]] >15,000 WBC/microliter
| |
| ** [[Anemia of chronic disease]]
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| | style="background: #F5F5F5; padding: 5px;" |'''Sputum analysis and culture'''
| |
| * Causative agents
| |
| | style="background: #F5F5F5; padding: 5px;" |Abscesses vary in size and are generally rounded in shape. The may contain only fluid or have a gas-fluid level. Typically there is surrounding consolidation, although with treatment the cavity will persist longer than consolidation.
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|
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| The wall of the abscess is typically thick and the luminal surface irregular. | | ==Overview== |
| | |
| | The [[mediastinum]] is a non-delineated group of structures in the thorax (chest), surrounded by loose connective tissue. Since it is the central compartment of the thoracic cavity, and it contains a lot of important structures, it is the site of involvement of various tumors. |
| | |
| | ==Causes== |
| | |
| | |
| | |
| | ==Initial Evaluation== |
| | {{familytree/start}} |
| | {{Family tree |border=2|boxstyle=background: WhiteSmoke;| | | | | A01 | | | | |A01=<div style="float: left; text-align: center; height: 1.25em; width: 25em; padding: 1em;">'''Mediastinal Mass'''</div>}} |
| | {{familytree | | | | | |!| | | | | | | | }} |
| | {{familytree | | | | | B01 | | | |B01=<div style="float: left; text-align: left; line-height: 150%; padding: 1em; "> '''Workups''' |
| | ---- |
| | ❑ CT chest with contrast <br> ❑ Serum beta-HCG, AFP, if appropriate <br> ❑ CBC, platelets <br> ❑ PET-CT scan (optional) <br> ❑ Pulmonary function tests if clinically indicated <br> ❑ MRI chest if clinically indicated |
| | </div>}} |
| | {{familytree | |,|-|-|-|^|-|-|-|.| | | | | | | }} |
| | {{familytree | C01 | | | | | | C02 | | | |C01=<div style="float: left; text-align: center; height: 1.25em; width: 15em; padding: 1em;"> '''Thymic Tumor Likely''' </div> |C02= <div style="float: left; text-align: center; height: 1.25em; width: 15em; padding: 1em;"> '''Thymic Tumor Unlikely''' </div>}} |
| | {{familytree | |!| | | | | | | |!| | | | | }} |
| | |
| | {{familytree | D01 | | | | | | D02 | | | |D01=<div style="float: left; text-align: center; height: 1.25em; width: 15em; padding: 1em; text-size: 85%;">Consider [[Thymoma surgery|surgery]]</div>|D02=<div style="float: left; text-align: center; height: 1.25em; width: 15em; padding: 1em; text-size: 85%;">Disease-specific management</div>}} |
| | |
| | {{familytree/start}} |
|
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| Bronchial vessels and bronchi can be traced as far as the wall of the abscess, whereupon they are truncated.
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| *
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| | style="background: #F5F5F5; padding: 5px;" |Clubbing of finger
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| |-
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| | style="background: #DCDCDC; padding: 5px; text-align: center;" |Septic emboli
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| | style="background: #F5F5F5; padding: 5px;" |
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| |-
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| | style="background: #DCDCDC; padding: 5px; text-align: center;" |Fungi
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| | style="background: #DCDCDC; padding: 5px; text-align: center;" |Parasites
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| |-
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| | style="background: #DCDCDC; padding: 5px; text-align: center;" |Mycobacterial infections
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| |-
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| | style="background: #DCDCDC; padding: 5px; text-align: center;" |Chronic inflammatory conditions
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| | style="background: #F5F5F5; padding: 5px;" |
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| |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
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| !Diseases
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| ! colspan="1" rowspan="1" |Cough/Sputum
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| ! colspan="1" rowspan="1" |Cough/Sputum
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| !Weight loss
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| !Other symptoms
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| ! colspan="1" rowspan="1" |Percussion
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| !Auscultation
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| !CBC
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| !Sputum analysis
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| !Chest X-ray
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| !CT scan
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| !Other imaging
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| !Histopathology
| |
| |'''Gold standard'''
| |
| !Additional findings
| |
| |-
| |
| | style="background: #DCDCDC; padding: 5px; text-align: center;" |Pulmonary AVMs
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| | style="background: #F5F5F5; padding: 5px;" |
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| |-
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| | style="background: #DCDCDC; padding: 5px; text-align: center;" |Pneumoconioses
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| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| |-
| |
| | style="background: #DCDCDC; padding: 5px; text-align: center;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| |-
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
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| |
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| |
| |
| |
| |
| |
| |
| |
| |
| |
| |}
| |
|
| |
|
| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |