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同步性脑与肺部病变:一项诊断挑战。

Synchronized Brain and Pulmonary Lesions: A Diagnostic Challenge.

作者信息

Ramesh Nithesh Babu, Reddy Keesari Sai Sandeep, Rangan Abinaya Srinivasa, Anandan Govindaraj Vimal Kumar, Kalappan Mahendra Kumar

机构信息

Internal Medicine, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND.

General Medicine, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND.

出版信息

Cureus. 2024 Aug 16;16(8):e66990. doi: 10.7759/cureus.66990. eCollection 2024 Aug.

DOI:10.7759/cureus.66990
PMID:39280419
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11402274/
Abstract

This case report details a 50-year-old female presenting with pulmonary and neurological symptoms initially diagnosed as disseminated tuberculosis, leading to treatment with antitubercular therapy. Despite initial improvements, daily bedside evaluations revealed a new cervical lymph node, which, upon further investigation, revealed features suggestive of malignancy. Further biopsy confirmed the diagnosis of adenocarcinoma of the lung with cerebral metastases. The patient was started on palliative chemotherapy but eventually succumbed due to complications. This case underscores the diagnostic challenge of approaching synchronous cerebral and pulmonary lesions, highlighting the critical role of thorough daily evaluations in accurate diagnosis and timely intervention. While the initial diagnosis focused on tuberculosis, the discovery of the cervical lymph node was pivotal in identifying metastatic lung adenocarcinoma. This case emphasizes the importance of considering malignancy in similar clinical scenarios and using comprehensive diagnostic approaches, including advanced imaging and timely biopsies, to ensure accurate diagnosis and appropriate management.

摘要

本病例报告详细介绍了一名50岁女性,最初表现为肺部和神经系统症状,最初被诊断为播散性结核病,并接受了抗结核治疗。尽管最初有改善,但每日床边评估发现了一个新的颈部淋巴结,进一步检查显示其特征提示为恶性肿瘤。进一步活检确诊为肺腺癌伴脑转移。患者开始接受姑息化疗,但最终因并发症死亡。本病例强调了处理同步性脑和肺部病变时的诊断挑战,突出了每日全面评估在准确诊断和及时干预中的关键作用。虽然最初的诊断集中在结核病上,但颈部淋巴结的发现对于识别转移性肺腺癌至关重要。本病例强调了在类似临床情况下考虑恶性肿瘤的重要性,并使用包括先进影像学和及时活检在内的综合诊断方法,以确保准确诊断和适当管理。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/11fe/11402274/c5c54c347929/cureus-0016-00000066990-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/11fe/11402274/b0a657f5995d/cureus-0016-00000066990-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/11fe/11402274/c5c54c347929/cureus-0016-00000066990-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/11fe/11402274/b0a657f5995d/cureus-0016-00000066990-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/11fe/11402274/c5c54c347929/cureus-0016-00000066990-i02.jpg

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本文引用的文献

1
Miliary brain metastases from lung adenocarcinoma as non-enhancing lesions on MRI: a case report and literature review.肺腺癌的粟粒性脑转移瘤在MRI上表现为无强化病变:一例报告及文献复习
Transl Cancer Res. 2021 Feb;10(2):1162-1168. doi: 10.21037/tcr-20-1898.
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Adenocarcinoma of the Lung Mimicking Miliary Tuberculosis.酷似粟粒性肺结核的肺腺癌
Case Rep Oncol. 2020 Feb 13;13(1):139-144. doi: 10.1159/000505685. eCollection 2020 Jan-Apr.
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Lung adenocarcinoma with miliary metastases mimicking disseminated tuberculosis.伴有粟粒样转移的肺腺癌,酷似播散性肺结核。
Jpn J Clin Oncol. 2019 Sep 1;49(9):888-889. doi: 10.1093/jjco/hyz107.
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J Med Imaging Radiat Oncol. 2018 Oct;62(5):654-661. doi: 10.1111/1754-9485.12779. Epub 2018 Aug 6.
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The diagnostic maze of synchronous mass lesions in brain and lung.脑与肺同步出现肿块性病变的诊断难题
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Management of brain metastases.脑转移瘤的管理
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