8. nódulo solitario
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Nódulo pulmonar solitario• Lesión redondeada u oval, menor de 4-6 cm de diámetro , de
cualquier contorno, ya sea redondeado , lobulado o umbilicado, que puede estar cavitado, presentar calcificaciones y tener pequeñas lesiones satélites.
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• Los nódulos solitarios son frecuentemente hallazgos en estudios radiográficos del tórax. Los criterios diagnósticos del nódulo pulmonar están en relación con su forma , contorno, localización, presencia de calcificación, crecimiento, cavitación , etc.
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ETIOLOGÍA
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NPS Etiología• CONGENITA
• Quiste broncogénico• MAV• Atresia bronquial congénita
• TRAUMATICA• Hematoma
• MISCELANEA• Granulomatosis
deWegener• AR• Amiloidosis• Atelectasia redonda
• INFECCIOSA• Tuberculosis (1º-granul)• Hongos• Hidatidosis• Neumonía organizada
• NEOPLASICA• Ca Broncogénico (2º)• Carcinoide• Hamartoma• Metastasis• Linfoma
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CAUSAS
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FACTORES DE RIESGO
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Cuadro Clínico:
Normalmente es asintomático.
Se encuentra como hallazgo incidental.
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Signos Radiológicos
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Nódulo Pulmonar Solitario: Modalidades de Evaluación
• Radiografía simple (PA, lat)
• TC• Simple
• Contraste IV
• PAAF/biopsia
• RM con GD-DTPA
• PET con FDG-F18
Dos principios básicosDetección de la lesiónCaracterización de la lesión
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Tamaño
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BORDES
• LISOS• ESPICULADOS• IRREGULARES
N Engl J Med 2003;348:2535-2542
Los bordes que indican malignidad incluyen: irregularidad, espiculación y lobulación
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BORDESBORDES
• Corona radiada• Líneas finas que se
extienden 4-5 mm• Espiculadas • 84 – 90% son
malignas
N Engl J Med 2003;348:2535-2542
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BORDES
• Bordes festoneado con Probabilidad intermedia de cáncer
N Engl J Med 2003;348:2535-2542
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• Las calcificaciones en palomitas de maíz se encuentran hasta en un tercio de los hamartomas.
• La TAC AR puede mostrar grasa o cartílago en la mitad de los casos.
Estudio del nódulo pulmonar solitario. A. Conde Valero, E. Navascués Martínez
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Hamartoma
Moodle.fcm.unc.edu.ar. Estudio del nódulo pulmonar Solitario Pag. 3.
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Laminado o patrón central típico de granuloma.
Los otros modelossuelen observarse en los granulomas asociados a
tuberculosis e histoplasmosis
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Histoplasmosis
Estudio del nódulo pulmonar solitario, pag. 4, Histoplasmosis.
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TIEMPO DE DUPLICACIÓN DE VOLUMEN
EL crecimiento de un NODULO
en estudios de imagen es una
herramienta
Muy utilizada en el de un NPS.
Expresado en términos de
duplicación de volumen;
Debido a su forma esférica, duplica
Cuando el diámetro aumenta en un 26 %
PERIODO DUPLICACIÓN
suele estar entre 20 y 400 días
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Ejemplos
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1: Nódulo redondeado de bordes bien definidos que contiene calcificaciones "en palomitas de mafz». por hamartoma.
2: Nódulo de bordes muy mal definidos con espiculaciones que salen de toda su superficie (flechas) en un adenocarcinoma primitivo.
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58Radiografía anteroposterior (A) y TC (B) muestran un nódulo de 1.5 cm de aspecto benigno - granuloma calcificado
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59Quiste hidatídico. Una situación rara: nódulo benigno >3 cm. Radiografía anteroposterior (A) y TC (B) muestran un quiste bien definido.
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3: Carcinoma epidermoide pulmonar con umbilicación en su parle superior (U).
4: Carcinoma de células pequeñas (T) mostrando una clara prolongación hasta la pleura. «cola pleural» (flecha).
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