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Paper 4
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
A 45 year old male smoker presents with chest pain and cough. After an abnormal chest radiograph, he has a CT which shows a 2-cm pleurally based soft tissue lesion in the left upper lobe with evidence of rib invasion. There is a further 11-mm pulmonary nodule in the left upper lobe. There are enlarged right hilar and mediastinal nodes including the left lower paratracheal lymph node as well as a left-sided pleural effusion. Biopsy of the pleural based lesion demonstrates primary lung cancer.
Tuberculosis in Childhood and Pregnancy
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
Lindsay H. Cameron, Jeffrey R. Starke
The tubercle foci in the regional lymph nodes develop some fibrosis and encapsulation, but the healing in this location is often less complete than in parenchymal lesions. Viable M. tuberculosis bacilli may persist for decades after calcification of these nodes. The size of these lymph nodes remains normal in most cases of primary tuberculosis infection. If these lymph nodes enlarge during the host inflammatory reaction, due to their location, hilar and paratracheal lymph nodes may exert external pressure on a regional bronchus. Partial obstruction caused by external compression leads to hyperinflation of the distal lung segment. Complete obstruction may result in atelectasis of the entire lung segment.2,41,42 These children often present with respiratory distress or failure and can have audible wheeze or diminished breath sounds on pulmonary examination. More often, caseous lymph nodes attach to and erode through the bronchial wall and can transmit infection to the lung parenchyma leading to bronchial obstruction and atelectasis. The resultant radiographic finding is referred to as “epituberculosis,” “collapse-consolidation,” and “segmental” tuberculosis. Rarely, intrathoracic tuberculous nodes invade adjacent structures, such as the pericardium or esophagus.
Management of Nodal Metastasis in Thyroid Cancer
Published in Madan Laxman Kapre, Thyroid Surgery, 2020
Neeti Kapre Gupta, Ashok Shaha, Madan Laxman Kapre, Nirmala Thakkar, Harsh Karan Gupta
The American Thyroid Association Consensus Statement on central compartment neck dissection clearly defines anatomical boundaries, indications, and terminologies for surgical procedures [27]. The central compartment extends between the carotid arteries laterally on either side, superiorly from hyoid bone and inferiorly up to the innominate artery. This includes the pre-laryngeal (delphian), pre-tracheal, and paratracheal lymph nodes. Level VII lymph nodes are the superior mediastinal lymph nodes.
Mediastinal lymphadenopathy: a practical approach
Published in Expert Review of Respiratory Medicine, 2021
Hariharan Iyer, Abhishek Anand, PB Sryma, Kartik Gupta, Priyanka Naranje, Nishikant Damle, Saurabh Mittal, Neha Kawatra Madan, Anant Mohan, Vijay Hadda, Pawan Tiwari, Randeep Guleria, Karan Madan
Knowledge of anatomy and these nodes’ relative location highlights that several lymph nodes lie near the tracheobronchial wall (2 R, 2 L, 3P, 4 R, 4 L, 7, 10 R, 10 L, 11Rs, 11Ri and 11 L, 12) (Figure 1B). These stations are accessible for sampling via an endotracheal (bronchoscopic or endobronchial ultrasound-guided) approach. Some lymph nodes (station8 and 9) are lying away from the airway but near the esophagus, making them accessible for sampling via a trans-esophagal ultrasound-guided route (Figure 4). Some lymph nodes stations are accessible by either a tracheal or esophagal approach (left-sided paratracheal lymph nodes [2 L, 4 L], 3P, 7). Rarely, grossly enlarged 4 R node may also be accessible via an esophagal approach. Specific lymph nodes (station 5 and 6) are distant from both the trachea and esophagus. Conventionally, they are inaccessible via either a tracheal or esophagal approach. Knowledge of these anatomical relationships is essential whenever a minimally invasive sampling of these lymph nodes is considered. This information allows the use of the appropriate modality for tissue sampling.
Surgical Outcomes and Efficacy of Isthmusectomy in Single Isthmic Papillary Thyroid Carcinoma: A Preliminary Retrospective Study
Published in Journal of Investigative Surgery, 2021
Hee Won Seo, Chang Myeon Song, Yong Bae Ji, Jin Hyeok Jeong, Hye Ryoung Koo, Kyung Tae
In this study, prophylactic CND was performed in 104 (86%) patients. Among the patients who underwent prophylactic CND, 24 patients (34.3%), 11 patients (27.5%), and 4 patients (36.4%) showed occult central cervical lymph node metastasis (N1a) in the total thyroidectomy, lobectomy, and isthmusectomy groups, respectively. In one recurrent case of this study, PTC recurred in the contralateral central lymph node. Song et al7 suggested that complete bilateral central neck dissection should be considered for isthmic PTC because of the higher rate of bilateral central lymph node metastasis than that of non-isthmic PTC (57.8% vs. 22.8%; p < 0.001). Wang et al10 also showed that occult central lymph node metastasis and paratracheal lymph node metastasis were detected in 46.6% and 38.4%, respectively, in isthmic PTC patients. Therefore, the need for prophylactic CND might be considered in patients with isthmic PTC considering the high rate of occult metastasis and recurrences in the central compartment lymph node.
Paraneoplastic Neurologic Symptoms in a Pediatric Patient with Hodgkin Lymphoma
Published in Cancer Investigation, 2021
Claire C. Baniel, Sarah S. Donaldson, Catherine Aftandilian, Susan M. Hiniker
Approximately 3 years after her initial presentation, she developed worsened left supraclavicular lymphadenopathy as well as severe dysphagia with inability to tolerate oral intake and with slightly less than 10% body weight loss in 3 months. Esophagram showed narrowing of the gastroesophageal junction with “no evidence of adenopathy surrounding the esophagogastric junction,” concerning for achalasia Figure 1. Esophagogastroduodenoscopy (EGD) was performed, which showed narrowing at the lower esophageal sphincter (LES) that could not be dilated with air, though with gentle pressure, the endoscope could be passed through the LES into the stomach. CT chest showed slight interval increase of the right paratracheal lymph nodes without esophageal mass effect (stable subcarinal and hilar nodes from prior; Table 1). Excisional biopsy of the left supraclavicular lymph node confirmed EBV+ lymphocyte rich classical HL, CD30+, MUM1+ (2), with variable to weak expression of CD20 and PAX5, and CD45 negative. Biopsy of the esophagus showed no significant abnormality and no evidence of HL involvement.