Pulmonary Neoplasm

Hari ni saya dapat baca chest x-ray patient with primary lung tumor, and milliary finely nodule suspect lung tuberculosis (orang melayu pggl batuk TB). So saya nak recall ape yang specialist ajar tadi psl lung tumour. Basically we divide into primary and secondary lung tumor untuk memudahkan pembelajaran. Tumor di thorax cavity ada 3 location :

1. Pleura
2. Mediastinum
3. Lungs

Primary lung carcinoma (cancer) 90% is bronchogenic carcinoma. While secondary lung carcinoma are due to metastases from cancer in extrathoracic organ (Eg breast cancer yang spread to lungs). So, doctors basically have to understand this nature, weather the lesion came up from primary or secondary lung carcinoma. In order to know this, there are a few features that will help us indicate this. Signs of metastases in chest radiograph (secondary lung carcinoma) are as follows :

- single nodule (coin lesion) type
- coarsely nodule type
- finely nodule (pneumonic type)
- golfball (Eg : melanoma maligna)
- lymphatic spread type
- pleural effusion (hemorrhagic)

Image 1 : PA chest radiograph in a 50-year-old man with non-Hodgkin lymphoma shows an opacity (E) in the lower left hemithorax with obliteration of the left hemidiaphragm and a curvilinear upper margin (arrow) and a mediastinal shift to the right. These findings are typical of a pleural effusion. In addition, minimal blunting of the right costophrenic angle is present. Cardiomegaly and a possible mediastinal mass are noted. Large free pleural effusion appears as a dependent opacity with a meniscus-shaped contour. Saya nak stress on "meniscus sign" kat image ini yang very indicative to pleural effusion.

Source : EMedicine

Image 2 : Localized tumor of the pleura. Tumor ni asalnye dari pleura. Macam mana nak tau? Tumor pleura ada ciri-ciri well-defined border (tengok pic tu, border die sangat clearly delineated from adjacent lung) dengan membentuk sudut >90 degree (sudut tumpul). Unlike tumor yang asalnye dari lungs, biasanya poorly defined border dengan sudut tajam (ukur sudut dari vertebra to the tumor). Tumor pleura usually suka "menyusup" dan bertumbuh masuk ke paru-paru coz dia xboleh expand itself kalau die membesar ke luar. Sebab kat luar ada costae yang menghalang (tulang rusuk yang membataskan pembesaran dia).

Tumor pleura selalu comes with pleural effusion because this tumor will disturb the pleural fluid balance. So if u ragu-ragu betul ke tak tumor pleura, try to find signs of pleural effusion (blunt costopherenic angle or meniscus sign), if ada, then most probably kecurigaan anda betul!

Source : Image Consult