Differential Diagnosis in Conventional Radiology

Transcription

1 Differential Diagnosis in Conventional Radiology Bearbeitet von Francis A. Burgener, Martti Kormano, Tomi Pudas Neuausgabe Buch. 872 S. Hardcover ISBN Format (B x L): 21 x 29,7 cm Weitere Fachgebiete > Medizin > Klinische und Innere Medizin Zu Inhaltsverzeichnis schnell und portofrei erhältlich bei Die Online-Fachbuchhandlung beck-shop.de ist spezialisiert auf Fachbücher, insbesondere Recht, Steuern und Wirtschaft. Im Sortiment finden Sie alle Medien (Bücher, Zeitschriften, CDs, ebooks, etc.) aller Verlage. Ergänzt wird das Programm durch Services wie Neuerscheinungsdienst oder Zusammenstellungen von Büchern zu Sonderpreisen. Der Shop führt mehr als 8 Millionen Produkte.

2 442 Chest Hilar and/or Mediastinal Lymph Node Enlargement Neoplastic diseases (malignant or benign) Bronchogenic carcinoma (Fig ) Hodgkin s disease (Fig ) Non-Hodgkin s lymphoma Leukemia Unilateral hilar node enlargement involving bronchopulmonary and tracheobronchial nodes, in some cases paratracheal and posterior mediastinal nodes. Bilateral but asymmetric enlargement, especially of paratracheal and tracheobronchial nodes, frequently also anterior mediastinal and retrosternal nodes. Bronchopulmonary nodes are less frequently enlarged than the more central ones. Unilateral involvement is very rare. Bilateral, asymmetric node enlargement similar to Hodgkin s disease. Usually symmetric enlargement of mediastinal and bronchopulmonary nodes. Influence of cell type: 1 A hilar mass as the sole roentgenographic abnormality is characteristic of an undifferentiated small-cell carcinoma; 2 Generalized mediastinal widening almost certainly indicates spread from an undifferentiated carcinoma; 3 Hilar or mediastinal lymph node enlargement is rare in alveolar cell (bronchiolar) carcinoma. Mediastinal lymph node enlargement is seen on the initial chest roentgenogram in approximately 50 % of patients. May be associated with pulmonary involvement or pleural effusion in advanced cases. May occasionally present as parenchymal consolidation without associated lymph node enlargement. Occurs in 25 % of patients, more commonly in lymphocytic than in myelocytic leukemia. Pleural effusion and parenchymal involvement may be associated. Fig Small cell carcinoma with mediastinal lymph node metastases and lymphangitis carcinomatosa. Enlarged right tracheobronchial lymph nodes (asterisk) and subtle obliteration of the notch between aorta and main pulmonary artery by metastatic lymph nodes (arrow). Fig Hodgkin s disease. Enlarged anterior mediastinal and hilar lymph nodes. Intrapulmonary mass lesion in the left lung. Fig a d Bronchopulmonary amyloidosis. a, b Hilar and azygos nodes are enlarged, with a pattern similar to sarcoidosis. Even small pulmonary densities occur, c, d The same patient, 6 years later. Unlike sarcoidosis, the hilar and mediastinal lymph nodes continually grow. Miliary parenchymal changes have also increased.

3 17 Mediastinal or Hilar Enlargement 443 (Cont.) Hilar and/or Mediastinal Lymph Node Enlargement Immunoblastic lymphadenopathy (a hyperimmune disorder of B lymphocytes) Heavy-chain disease (a plasma cell dyscrasia) Bronchopulmonary amyloidosis (a plasma cell dyscrasia) (Fig ) Bilateral, asymmetric node enlargement similar to Hodgkin s disease. Symmetric enlargement of mediastinal lymph nodes. Symmetric hilar and mediastinal lymph node enlargement. Enlarged nodes may be densely calcified. Lungs are occasionally affected in a pattern similar to Hodgkin s disease. Hepatosplenomegaly is common, lung involvement rare. Sometimes associated with diffuse pulmonary involvement. (continues on page 444) a b c d

4 444 Chest (Cont.) Hilar and/or Mediastinal Lymph Node Enlargement Lymph node metastases (Fig ) Unilateral or bilateral enlargement of either hilar or mediastinal nodes or both. May be associated with lymphangitic changes in the lungs (see Table 17.3). Post-transplantation lymphoproliferative disorder (PTLD) Castleman s disease (giant lymph node hyperplasia) Bacterial and mycoplasma infections Primary tuberculosis (Fig ) Tularemia (Francisella tularensis) Pertussis (whooping cough) Anthrax (Bacillus anthracis) Plague pneumonia (caused by Yersinia pestis) Mycoplasma pneumoniae Viral, rickettsial infections Rubeola Echovirus pneumonia Varicella pneumonia Psittacosis (ornithosis) Epstein-Barr (infectious mononucleosis) (Fig ) AIDS (acquired immunodeficiency syndrome) (Figs and 17.17) Hilar and mediastinal lymph node enlargement often associated with pulmonary nodules measuring up to 5 cm in diameter. Rarely pleural and/or pericardial effusion/thickening is also evident. Hilar or mediastinal nodes or both. Large circumscribed mediastinal mass is the most common presentation. Mostly unilateral hilar (60 %) or hilar and paratracheal (40 %) lymph node enlargement. Bilateral node enlargement is a rare presentation. Unilateral hilar node enlargement with characteristically oval pneumonic consolidations and pleural effusion. Unilateral hilar node enlargement. Symmetric enlargement of all lymph nodes or generalized mediastinal widening. Symmetric hilar and paratracheal node enlargement. Unilateral or bilateral hilar lymph node enlargement associated with segmental pneumonia, predominantly in lower lobes. Unilateral or bilateral hilar node enlargement. Bilateral hilar node enlargement may be associated with diffuse interstitial pneumonia. Bilateral hilar node enlargement and associated increase of bronchovascular markings. Bilateral hilar node enlargement associated with patchy, diffuse air-space consolidation. Unilateral or bilateral hilar node enlargement associated with variable radiographic presentations of pneumonia. Bilateral, symmetric, predominantly hilar lymph node enlargement. Bilateral lymph node enlargement. Lymphocyte proliferation developing 1 month to 1 year after transplant. Histologic range from benign hyperplastic proliferation to malignant lymphoma. Related to Epstein-Barr virus-infected B-cells. This rare benign condition may be associated with fever, anemia and gammaglobulinemia. Two types can be differentiated. Type 1: the hyaline vascular type (90 %), almost always local, with no systemic symptoms; Type 2 the plasma-cell type, which may be multicentric and associated with systemic symptoms. Hilar node enlargement differentiates primary from secondary (reunification) tuberculosis. In the latter, there is no observable lymphadenopathy. Ipsilateral hilar node enlargement occurs in % of tularemic pneumonias. Is a potential bioterrorism agent. Often associated with ipsilateral segmental pneumonia and atelectasis. Often associated with pleural effusion, rarely with pulmonary hemorrhages. Has been used as a bioterrorism weapon Nonsegmental homogeneous consolidations may occur in lungs mimicking alveolar edema. May be used as a bioterrorism weapon. Most common in children. Together with parenchymal disease. If pneumonia in rubeola is segmental, it is due to secondary bacterial infection. Respiratory infections occur predominantly in infants. Pulmonary consolidation may mask hilar node reaction. Mainly occurs in adults with varicella. Roentgenographic resolution of pneumonia is slow. Splenomegaly. Roentgenographic changes in the lungs are rare. Lymphadenopathy is common in AIDS patients (up to 80 %); most often related to chest infections, less commonly caused by AIDS-associated lymphoma. (continues on page 446)

5 17 Mediastinal or Hilar Enlargement 445 Fig Metastatic melanoma with lymphangitis carcinomatosa and bilateral hilar lymph node enlargement. Fig Primary tuberculosis in a patient with AIDS. Right hilar lymph node enlargement. Fig Infectious mononucleosis. Enlargement of bronchopulmonary nodes and the azygos node a pattern characteristic of sarcoidosis. Fig Benign mediastinal lymphadenopathy in AIDS. Lymph nodes on the right side are predominantly enlarged, both in the hilar and the upper mediastinal regions.