Agenda
Brief introduction
Radiological Modalities
Radiological Features
Radiological Imaging Of Complications
Definition
Risk Factors
Cigarette smoking
Radon gas
Industrial exposure e.g. asbestos, arsenic, uranium
Concomitant disease e.g. Chronic pulmonary scar and
fibrosis
Preinvasive Lesions
Classification
According to anatomy:
cell carcinoma.
Peripheral lung cancer, mostly is adenocarcinoma and large cell
carcinoma.
According to histology:
Adenocarcinoma 30-40
Squamous cell carcinoma 30-40%
Large cell Undifferentiated carcinoma 10%
Continued
Classification
According to Pathology:
Clinical Features
Central tumors
Cough
Wheezing
Hemoptysis
Pneumonia
Extrapulmonary invasion
Pain
Pancoast syndrome
SVC Syndrome
Metastases
Paraneoplastic syndromes
Asymptomatic 10%
Imaging Modalities
Presentations of Lung
Tumor
Presentations of Lung
Tumor
Mass
ground-glass haziness
airway dilatation
Consolidation
Continued
CT Angiogram Sign
CT angiogram sign. A
patient with bronchoalveolar
carcinoma. Enhancing
pulmonary vessels in a lowattenuating mass are seen.
CT Angiogram Sign
cavitation
Cavitation (16%):
30
31
Central Mass
39
40
Mediastinal Widening
PET-CT
F-18 FDG PET imaging has been shown to be an accurate, noninvasive imaging test for the assessment of pulmonary nodules
and larger mass lesions
96 % sensitive, 93 % specific.
Several studies have shown that PET is more accurate than CT
for the staging of NSCLC.
PET appears to be more accurate than CT in detecting
metastatic mediastinal lymphadenopathy.
Detection of unsuspected metastatic disease by PET may
permit reduction in the number of thoracotomies performed
for non-resectable disease.
46
Unresectable lung
cancer. FDG-PET scan
shows large primary
tumour with metastases
in lymph nodes, bone, &
right adrenal.
48
50
bronchogram sign.
Golden S sign
Golden S sign. Collapsed right upper lobe with mass at right hilum.
60
CT of a collapsed right
upper lobe due to a
squamous cell carcinoma.
Note the peripheral air
bronchograms (arrow) in (A)
despite a central obstructing
mass with amorphous
calcification (B). There is a
convex border of the
collapsed lobe (arrows) (B)
which is the CT equivalent of
Goldens S sign.
Mucoid Impaction
64
65
Local Hyperaeration
Persistent peripheral
infiltrates
PA chest radiograph shows abrupt cut off of left main bronchus with
collapse.
75
Axial CT images show a large mass (stars) in the left lower lobe with a large
left pleural effusion with focal pleural thickening (arrowheads). The lung
mass is better seen on a post-thoracentesis image. Transbronchial biopsy
revealed adenocarcioma and pleural fluid cytology confirmed the presence
of malignant cells. Based on the new staging system, this patient has at least
M1a disease.
Frontal chest radiograph demonstrates a mass in the left lung apex (white arrow in left image).
There is associated destruction of the left 2nd and 3rd ribs posteriorly (white circle). The closeup photo of the left apex shows the rib destruction (white arrow) more clearly. The combination
of an apical mass with rib destruction is characteristic for a Pancoast Tumor.
Calcifications
a)
b)
c)
Calcified infectious
granuloma engulfed by lung
cancer. CT shows a cluster of
densely calcified small
nodules almost at the centre of
a small carcinoma.
Tumour calcification.
Large bronchial
carcinoma invading the
mediastinum
demonstrates coarse and
cloud-like calcification.
ANGIOGRAPHY
92
93
T= Tumour size
94
TNM STAGING
T1
T2
N1
N2
N3
M0
No metastases
M1
T3
T4
95
CONCLUSION / SUMMARY
CHEST
RADIOGRAPHY
COMPUTED
TOMOGRAPHY
97
POSITRON EMISSION
TOMOGRAPHY
RADIOLOGY OF COMPLICATIONS
LOCAL COMPLICATIONS:
Superior Vena Cava Syndrome
Intractable Hemoptysis
DISTANT COMPLICATIONS:
Metastases
PARANEOPLASTIC SYNDROMES:
Hypertrophic Osteoarthropathy
99
SVC SYNDROME
100
SVC SYNDROME
101
SVC SYNDROME
Swelling
Widening
102
103
Stenting of superior vena cava is a well-known but not so commonly used technique to alleviate this syndrome.
The catheter wire is placed in the vena cava stenotic segment. The stent is delivered and the stenosis is solved.
104
INTRACTABLE HEMOPTYSIS
106
Angiographic image
showing blood ejecting
from a ruptured bronchial
artery branch (arrow)
Selective embolization of
the feeding artery obtained
with gel foam.
107
HYPERTROPHIC
OSTEOARTHROPATHY
108
HYPERTROPHIC
OSTEOARTHROPATHY
109
HYPERTROPHIC
OSTEOARTHROPATHY
110
112
DISTANT METASTASES
113
DISTANT METASTASES
Lung cancer can spread to any region of the body, but most
commonly spreads to the liver, the lymph nodes, the brain,
the bones, and the adrenal glands.
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LIVER METASTASES
115
ADRENAL METASTASES
118
ADRENAL METASTASES
119
122
BONE METASTASES
123
BONE METASTASES
124
125
Bone Metastasis from Primary Lung Cancer expansile lytic rib lesions (arrows).
126
127
BRAIN METASTASES
129
BRAIN METASTASES
130
DIFFERENTIAL DIAGNOSES
Pulmonary metastases
Pulmonary AV malformation
133
DIFFERENTIAL DIAGNOSES
Pulmonary tuberculosis
Pulmonary hamartoma
134
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