This "pulmonary fibrosis and lung cancer" reading cheat, please put it away!

It only takes 3 minutes to finish reading! Learn new knowledge again! Today, let's learn about the series of CT reading films of pulmonary interstitial fibrosis combined with lung cancer ~ let's first look at a group of CT pictures (Fig. 1-3).figure 1-3 the above pictures are typical of pulmonary interstitial fibrosis, and the grid shadow mainly distributed under pleura can be seen! The damage repair process of pulmonary interstitial fibrosis, especially idiopathic pulmonary interstitial fibrosis, is similar to that of lung cancer.patients with pulmonary fibrosis are more likely to have lung cancer! More need to guard against lung cancer! More need to screen for lung cancer! According to some reports, the cumulative incidence rate of lung cancer in patients with idiopathic pulmonary fibrosis during follow-up first, fifth and tenth years is 3.3%, 15.4% and 54.7% respectively.next, let's take a look at the CT image of the patient's left lower lobe, which may be more helpful for diagnosis.Figure 4 and figure 5, we can see the mass in the fibrotic lesion of the left lower lobe of the patient! The diagnosis of pulmonary fibrosis combined with lung cancer can be basically made.Figure 6 and Figure 6 show the mediastinal lymph node enlargement, which further supports lung cancer.pulmonary interstitial fibrosis is easy to be complicated with lung cancer, and the risk of male, elderly and smokers is higher.in addition, emphysema may further increase the risk of canceration.unfortunately, this patient is also complicated with emphysema at the same time! Does the patient have lung cancer? What's the next step? Lung puncture is relatively easy to pneumothorax, patients with pulmonary interstitial fibrosis and emphysema, the focus is not close to the pleura, the risk of pneumothorax by bronchoscopy lung biopsy is relatively less, generally speaking, it is more appropriate.figure 8: however, after bronchoscopy, the patient developed fever and respiratory failure, and the number of chest CT lesions increased suddenly (Figure 8). Considering the acute exacerbation of interstitial pneumonia and concurrent infection, noninvasive ventilator assisted breathing, anti infection and anti-inflammatory treatment with methylprednisolone were given! Bronchoscopy is generally safe, but for interstitial pneumonia, bronchoscopy is more likely to worsen the condition, which requires caution.fortunately, the patient's bronchoscopic lung biopsy showed lung cancer! Figure 9 and figure 10 give the family an account at last! In addition, after noninvasive ventilator + anti infection + methylprednisolone anti-inflammatory treatment, the patient is finally in danger! The absorption of chest CT lesions was reexamined (Fig. 9, FIG. 10).how to treat it in the future? Pulmonary interstitial fibrosis, especially IPF (idiopathic pulmonary interstitial fibrosis) combined with lung cancer, is very difficult to treat. The treatment of lung cancer includes surgery, chemoradiotherapy and targeted therapy, which may aggravate interstitial lung disease! Surgery is not a contraindication! Two new drugs developed in recent years: pirfenidone and nidanib, may bring new hope for the treatment of such patients.just mentioned above is a very typical pulmonary interstitial fibrosis + lung cancer + emphysema, but what to do if you encounter an atypical patient? 1. Nodules should be followed up. CT scan of this patient revealed irregular subpleural nodules in the right lower lobe of the lung (FIG. 11).after 114 months of reexamination, the nodules in the right lower lobe of the lung were enlarged, and the surgical pathology was squamous cell carcinoma.2. Consolidation should be followed up, nodules should be followed up, consolidation lesions should also be followed up, many interstitial pneumonia generally do not show consolidation, especially IPF consolidation.the following patient (Fig. 12) was followed up and found that the solid lesion did not disappear, no absorption was found on CT Reexamination, and the biopsy pathology was squamous cell carcinoma.fig123, it's impossible to guard against it. Let your imagination play! The patient below (Figure 13) is very atypical, and lung cancer should be considered. we need to imagine: simple pulmonary interstitial fibrosis generally does not have pleural effusion, and the focus consolidation should be alert to lung cancer. Fig. 13 of course, the diagnosis of pulmonary interstitial fibrosis + lung cancer still needs pathological drip. 4! Here's a patient (Figure 14) with subpleural pulmonary fibrosis and streaky shadows in the upper left lobe. Figure 14 in general, when we see the Striped shadow, we all have a indifferent expression. however, after 9 months of CT scan, the left upper lobe of the lung showed increased striped shadow and ground glass. The pathology of thoracoscopic resection was adenocarcinoma. I dare not say that the strip shadow does not need to be processed next time! Especially in patients with pulmonary interstitial fibrosis. References: 1. Elining, Wang Ronghua, Wu Shan, Wu Zhifeng. CT features and dynamic evolution of lung cancer in the background of interstitial fibrosis [J]. Chinese Journal of clinical medical imaging, 2017,28 (6): 412-415.2. Zhang Yaqiong, Liu Shuang. Progress in diagnosis and treatment of idiopathic pulmonary fibrosis complicated with lung cancer [J]. Medicine and philosophy, 2018,39 (10): 65-69