Phổi lâm sàng

Tip cn lm sng

Trng hp lm sng

HNH CHNH :

Bnh nhn nam, 57 tui, a ch Bn Tre

Ngh nghip : nng dn

L DO NHP VIN: au ngc

BNH S :

Bnh nhn au ngc (T) m , iu tr bng thuc

gim au ti trm y t, nhng khng gim. au ngc ngy

cng tng dn, khm ti BV Bn Tre, chp X quang pht

hin bu phi nn chuyn BV Ung Bu

Trng hp lm sng

TIN CN:

- Ht thuc l: gi/ ngy x 30 nm

- Ung ru: thnh thong, khi c tic.

- Khng bnh l ni ngoi khoa.

VN CA BNH NHN:

au ngc

Bu phi

Chn on ung th

1. Chn on c quan mang bu

2. Chn on bn cht bu

3. Chn on giai on bnh

4. Chn on bn cht sinh hc bu

Lm sng Cn lm sng

Tnh hung lm sng

1. Pht hin tnh c

2. Triu chng ca bu nguyn pht

- Ho

- Ho mu

- Nng ngc

- Kh th

- Kh kh

- Vim phi

Tnh hung lm sng

3. Triu chng ca bu lan rng

trong lng ngc

- au ngc

- Hi chng tnh mch ch trn

- Khn ting

- Nut kh

- U Pancoast: au vai, cnh tay,

hi chng Horner

Tnh hung lm sng

4.Triu chng di cn:

- Ni hch c, hch nch.

- au xng, gy xng bnh l.

- Gan to, bng bng.

- Hi chng tng p lc ni s, du thn kinh khu tr.

- Ni cc u, cc di da.

Tnh hung lm sng

5. Triu chng tng qut:

- St cn

- Chn n

- Yu sc

- Hi chng cn ung th.

Bnh nhn thng n giai on tr, do c rt t triu chng giai on sm Ung th phi l k git ngi thm lng

Chn on Tnh hung lm sng


X quang ngc



CT scan ngc

Chn on


CT ngc

- Pht hin bu.

- nh gi kh qun, ph qun chnh.

- Pht hin xm ln thnh ngc.

- nh gi xm ln mch mu.

- Pht hin di cn.

- nh v v hng dn sinh thit

bu

Chn on

1. Chn on c quan mang buMRI ngc

- Pht hin bu nm trong

vng phi xp

- Chng ch nh tim thuc cn

quang/ chp CT

Chn on

2. Chn on bn cht bu

Xquang ngcCT ngcMRI ngcPET_CT

Bu ngoi vi Bu trung tm

- Sinh thit qua da- Ni soi lng ngc- Ni soi ph qun- M ngc thm st

- T bo hc/ m.- Ni soi ph qun- M ngc thm st

Chn on

Chn on

2. Chn on bn cht bu

Ni soi ph qun


2. Chn on bn cht bu

FNA xuyn thnh ngc : Carcinm tuyn

Chn on

2. Chn on bn cht bu

Ung th phi khng t bo nh (80%)

Ung th phi t bo nh (20%)

Carcinm

tuynCarcinm

t bo gaiCarcinm

t bo ln

10 15% 35 - 40% 30%

Chn on


Chn on


PET _CT

nhy : 89% c hiu 94%



- Siu m:

Hch trn n (P) 10 mm, ngh hch di cnGan bnh thng. Khng thy di cn tuyn thng thn.

- X hnh xng: bnh thng.

- MRI no: bnh thng

FNA hch trn n (P): hch vim

Chn on

- Kch thc bu.- V tr bu so vi Carena.- Xp phi, vim phi.- Xm ln: mng phi, trung tht, tim,

mch mu ln, kh qun, thc qun, ct sng, carena.

- Bu cc thy phi

- V tr hch di cn- Hch cng bn/ i bn.- Hch trn n

- Trn dch mng phi, mng tim.- Bu thy phi i bn- Di cn xa

T

N

M

Chn on

4. Chn on bn cht sinh hc

Chn on

Carcinm tuyn phi (T) cT3N0M0

KT LUN

- Triu chng ung th phi rt m h. Khi triu chng

r th bnh giai on tr.

- Chn on ch yu da vo cc phng tin cn lm

sng

- Cc phng tin chn on gii phu bnh ph thuc

vo v tr bu.

- Thng gp ung th phi khng t bo nh.

- Carcinm tuyn : ch bn cht sinh hc bu

Chn thnh cm n

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