Manifestations of Bronchogenic carcinoma

A change in the character of the regular cough of a smoker old male, particularly if it is associated with other new respiratory symptoms, should raise the possibility of ​

bronchogenic carcinoma

.​

I-Thoracic manifestations of Bronchogenic carcinoma

A- Bronchopulmonary presentations:
1- ​

Asymptomatic

(detected accidentally by routine x-ray as coin shadow)
2- ​

Cough

and ​

haemoptysis

:
Blood tinged sputum - Red current jelly i.e. sputum consist of Mucous, Tissue debris, RBCs

3- ​

Bronchial obstruction

• Partial ==> Emphysema , Bronchiectasis
• Complete ==> Lung collapse​

​

4- ​

Pneumonia

usually recurrent at the same site, or is slow to respond to treatment.

5- Lung​

abscess

(due to secondary infection)
6- ​

Thoracic inlet syndrome

may occur due to bronchial carcinoma in the apex of the lung (superior sulcus tumour) causing invasion of :
• Upper 3 ribs
• Sympathetic chain ===> ​

Horner syndrome

- Ipsilateral partial ptosis.
- Ipsilateral enophthalmos and a small pupil
- Ipsilateral hypohidrosis of the face.
• SVC obstruction (congested non pulsating neck veins)
• Lower trunk of brachial plexus (Pancoast's syndrome) :
- Pain in shoulter and inner - Wasting of the smal1 muscles of the hand
• Subclavian artery ===> unequal pulse volume in both upper limbs .

7- Cor pulmonale due to lymphangitis carcinomatosa.

B - Pleural presentations:

*​

Effusion

:
• Malignant effusion (​

Exudate

) : Massive ,Hemorrhagic, Rapidly re-accumulating

• ​

Transudate

: due to obstruction of azygos vein .
• ​

Chylous

: due to obstruction of the thoracic duct .
• ​

Empyema

: due to rupture of malignant abscess into pleura .

* ​

Dry pleurisy

may occur

C - ​

Mediastinal presentations

:
Mediastinal spread may result in dysphagia .

• Hypercalcemia is usually caused by squamous cell carcinoma.
• Syndrome of inappropriate ADH and ectopic ACTH seretion are usually associated with small cell carcinoma.
• Clubbing most often with non small cell carcinoma.
• Gynecomastia is usually with large cell carcinoma.
• Hypertrophic pulmonary osteoarthropathy is usually with adenocarcinoma.
• Neurological syndromes may occur with any type of bronchial carcinoma.​

II- Extra-thoracic manifestations of Bronchogenic carcinoma :

​