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    Volume 3 Issue1 Quiz1

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    Volume 3 Issue1 Quiz1

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    Volume 3 Issue1 Quiz1

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    Quiz

    Pulmonary Radiology Quiz


    *Venu K1, Yugaveer K2, Pradeep3, Chaitanya Goud3, Bhanu Teja3, Kiran3, Aditya3
    1
    Professor & HOD, 2Assistant Professor, 3Post Graduate, Department of Pulmonary Medicine, Kamineni Institute of Medical
    Sciences, Narketpally, Nalgonda District, Telangana State, India.

    1. What is the description of the above shown Chest X-ray

    2. What is the differential diagnosis?

    3. What are the investigations required for diagnose?

    *Corresponding author :
    Dr. Venu K,
    Professor and Head,
    Please refer page number 40 for the answer
    Department of Pulmonary Medicine,
    Kamineni Institute of Medical Sciences, Narketpally,
    Nalgonda District, Telangana State, India -508254
    [email protected]

    Journal of Basic and Clinical Research 2016; 3(1) : 39-41 39


    Venu K et al: Pulmonary Radiology Quiz

    Pulmonary Radiology Quiz - Answers • USG chest and abdomen


    • CT chest
    1. Chest X-ray shows multiple rounded nodular
    lesions of variable sizes involving both the • PET scan
    lungs, predominantly in mid and lower zones.
    Invasive investigations-
    Appearance of this X-ray is described as
    Cannonball Appearance. Routine blood investigations: CBP, ESR, CRP, RFT,
    LFT, RBS, HIV, HBsAg, HCV
    2. Cannonball appearance is seen in following
    conditions They can be classified in to Benign Anti CCP-antibody, R-factor
    and Malignant
    ANA, c-ANCA
    Benign conditions -
    Lung biopsy (open or closed)
    • Bacterial infections: Pulmonary tuberculosis,
    Staphylococcus pneumonia, Enterobacteria Bio-markers: AFP, Beta HCG
    pneumonia, Pseudomonas aeruginosa,
    Haemophilus influenzae, Pneumonia. Treatment
    • Fungal infections: Histoplasmosis, Above shown X-ray is case of secondaries in lung
    Coccidiodmycosis, Nocardiosis secondary to colonic carcinoma (stage 4) with poor
    • Parasitic infections: Hydatid disease, prognosis.
    Paragonimiasis
    Palliative chemotherapy is often used to treat
    • Connective tissue disorders: Rheumatoid metastatic lung cancer. Other modalities like Radiation
    disease, Wegners granulomatosis therapy, Laser therapy may be used. Appropriate
    • Autoimmune disorders: Sarcoidosis antibiotic/ antifungal therapy may be given in case
    of infectious causes. In patients with Arterio-venous
    • Congenital anomalies: Arterio-Venous malformations, sclerosing agents are given.
    malformations (Osler Rendu Weber
    Syndrome) Discussion
    Malignant conditions - Cannonball metastases refer to large, well
    circumscribed, round pulmonary metastases that
    Lung cancer (50%), Thyroid, Breast cancer , Renal
    appear, like cannonballs. The French term "envolée
    cell carcinoma, Choriocarcinoma (uterus & testes)
    de ballons" which translates to "balloons release" is
    or less common primary tumors:
    also used to describe this appearance.
    • Prostate cancer
    Multiple pulmonary nodules seen on plain chest
    • Synovial sarcoma
    X-ray have a multitude of causes, starting from
    • Endometrial carcinoma metastases (cannon ball secondaries), various
    • Osteogenic carcinoma infections, immunological diseases to arterio-venous
    malformations.
    3) Investigations required-
    Pulmonary metastasis is seen in 20-54% of
    Non-invasive investigations extrathoracic malignancies. Lungs are the second
    • Sputum for malignant cytology most frequent site of metastasis from extrathoracic
    malignancies. Development of pulmonary metastasis
    • Sputum for AFB, fungal elements, gram stain and
    implies disseminated disease with poor prognosis.
    culture sensitivity
    Breast, colorectal, kidney, head, neck and uterus
    • Chest X-ray

    40 Journal of Basic and Clinical Research 2016; 3(1) : 39-41


    Venu K et al: Pulmonary Radiology Quiz

    cancers are the most common primary tumors with References


    lung metastasis.
    1. Chapman S, Nakielny R. Aids to Radiological differential
    diagnosis, 4th ed., New Delhi: Saunders–Elsevier, 2003.
    The basic sign of haematogenous pulmonary
    metastases is one or more discrete pulmonary 2. Armstrong P. Pulmonary neoplasms. In: Grainger RG,
    nodules. Allison D (eds). Diagnostic Radiology: A Textbook
    of Medical Imaging, 3rd ed., Hong Kong: Churchill-
    Livingstone, 1997; Ch 20.
    The nodules are usually spherical and well-defined,
    but they may be almost of any shape and can 3. Sutton D. Radiology and Imaging for Medical Students,
    occasionally have a very irregular edge, especially in 7th ed., New Delhi: Churchill-Livingstone, 2001
    adenocarcinoma.2

    Secondary deposits can also present as miliary


    mottling throughout the lung fields or with extensive
    perihilar spread (lymphangitis carcinomatosa)

    Although metastases are an important and common


    cause of multiple pulmonary nodules on plain chest
    film, the diagnosis should be made with caution, taking
    into consideration all the relevant data available about
    the patient and the various differential diagnoses for
    multiple pulmonary nodules, mainly the infective
    causes.

    Journal of Basic and Clinical Research 2016; 3(1) : 39-41 41

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