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Case study on Non-Hodgkins Lymphoma
Transcript of Case study on Non-Hodgkins Lymphoma
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chest x-ray pre-OP
_ _ _ _ _ _ _ _ _ _
(General Portable X-ray)
Stage 4 Non-Hodgkins lymphoma situated in the Chest resulting in pleural effusion
Understanding the Problem
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Lymphatic System Components
Ancillary pain, discomfort in the spine and limbs caused by increasing neurological dysfunction.
Highest likelihood of poor survival.
•Having a disseminated tumor (stage IV)
•Disease has spread to more than one site beyond the lymph nodes
poor patient's functional ability
Elevated levels of the lactate dehydrogenase (LDH) protein
permanent decrease in anterior height
Anxiety and depresssion
somatic symptoms -> fatigue, pain and ache.
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A 52 years old male was admitted in the Emergency Department, bed ridden, complaining of short of breathness. According to the clinical information, patient was going through chemotherapy. He was requested for a chest x-ray to see the progression and the severity of his bilateral Pleural effusion that he developed on 16-10-12 as a complication of his Pre-diagnosed Stage 4 non-hodgkin lymphoma in the chest.
(reference of Information)
1. Merrill’s Atlas of Radiographic Positioning and Processing.Chapter 10 and 9 Bony thorax + thoracic viscera
3. Patient Operation record and discharge summary.
4.Patient report by the physician at dubai Hospital
Img.5 & 6 - http://www.wikiradiography.com/page/Lumbar+Spine+Radiographic+Anatomy
Img .7 & 8 - http://emedicine.medscape.com/article/1899053-overview#aw2aab6b3
10-14 : Dubai hospital, Impact system.
Fig.1 : http://images.yourdictionary.com/chest
Fig.2 : http://www.medicalnewstoday.com/articles/146136.php
Fig.3 : http://www.fpnotebook.com/_media/LumbarSpineAnatomyVertebra.gif
Fig.4 : http://emedicine.medscape.com/article/1899053-overview#aw2aab6b3
Bounded by thoracic aperature
supprts the walls of plueral cavity and diaphragm
volume can varied during respiration
Protects heart and lung
_ _ _ _ _ _ _ _
Functions the respiratory system and the cardiovascular system.
Non- hodgkins Lymphoma
Lymphoma: is a type of cancer that begins in immune system cells called lymphocytes. It occurs when lymphocytes are in a state of uncontrolled cell growth and multiplication.
Types of Lymphoma:
DO NOT! contain Reed-Sternberg cells and tend to develop in peripheral lymph nodes and spread throughout the body.
Enlarged lymph nodes
Swollen abdomen (belly)
Feeling full after only a small amount of food
Chest pain or pressure
Shortness of breath or cough
Fatigue (extreme tiredness)
Examinations to confirm:
Bone marrow aspiration and Biopsy
•Biologic therapy (immunotherapy)
•Stem cell or bone marrow transplantation
According to which Factors?!
•Stage (the extent of the tumor)
•Grade (the growth pattern of the tumor)
•Histologic type (cellular structure)
•Location of tumor
•blood levels of lactate dehydrogenase or patient's age and overall health status
Patient presented with a complaint of being short of Breath. On examination,
he was presented with fever and pain in movement , he was conscious and responsive to the instruction given.
Stage 4 of Non- Hodgkin lymphoma with bilateral pleural effusion and bilateral interstitial shadowing.
Abnormal results were found!
Medical Diagnotic Imaging:
a.MDI examination Procedure:
Check for Radio-opaque materials.
History of patient.
Evaluate co-operation ability range.
35 x 43 cm ( x1)
Large focal spot
Kvp: 68 , mAs: 2
Patient in semi-supine position.
Arms extended away, holding the side rail.
CR/CP- Perpendicular midway sternum
There was no complications. Patient was very co-operative hence we have achieved a sub-optimum image.
Due to patient being short of breath and in pain as well, movement was limited. Hence the rotation.
No positioning Aid.
Left sided pleural effusion is seen.
Right apical fibrotic strands are seen.
Diffuse bilateral interstitial shadowing is seen.
The cardiac shadow could not be commented upon.
The left dome of diaphragm is raised.
Bilateral pleural effusion with left lower lobe collapse
A 52 years old male was admitted in the Emergency Department, bed ridden, complaining of short of breathness. The patient according to clinical info was going through chemotherapy, he was requested for a chest x-ray on 5-3-2013 to see the progression of and the severity of his bilateral Pleural effusion that he developed on 16-10-12 as a complication of his Pre-diagnosed non-hodgkin lymphoma in the chest. Achieving poor outcomes, patient is deceased on 2-4-13.
(Img.5) AP chest x-ray
(Img.6) Axial CT image at the level of T7
(Img.10)PA chest showing left pleural effusion
(Img.11) PA chest showing pleural effusion
AP portable chest x-ray
(Img.13)AP portable chest x-ray
Expansion and Contraction of the lung.
Effectivness of MDI investigation:
CT Scan well demonstrated the severity
Name: Reem M. Alkaabi
Course instructor: Mrs. Mawada
Supervisor Name: Wiam Alshami
(Fig.1) Diagram of the Bony thorax
(Fig.2) Lymphatic system anterior view
(Fig.3) Lymph drainage flow; lymphatic duct anatomy.
(Fig.4) Lymph capillaries in spaces. Blind-ended lymphatic capillaries arise within interstitial spaces of cells near arterioles and venules.
-costal cartilage made of hyaline cartilage.
- 12 ribs divided into true and false
- rib nom. corresponds to the thoracic vertebrae.- - 1st to 9th rib the obliquity increases
- 10th to 12th rib obliquity decreases.
inferior portion of esophagus
cavity has 3 chambers:
Right pleural cavity
Left pleural cavity
•Fluid -> lymph
•Vessels -> transport lymph
•Organs -> lymphoid tissue
FUNCTION OF THE LYMPHATIC SYSTEM IS SIMPLE!
Its a one way system that returns lymph fluid to the cardiovascular system ( via vessels) for eventual elimination of toxic by products of end organs.
R A D
Interstitual fluid and and Protiens to blood
fats and fat-soluble vitamins from the digestive system and transport of these elements to the venous circulation
against invading organs
2. Lymphatic Vessels
3. Lymph Nodes
Normal Radiographic Anatomy
* CT, US and x-ray.
* Lab investigation: CBC, LDH
1. Patient was semi supine
2. Midsagital plane is not perpendicular with the IR.
The radiation and chemo therapies used in treating NHL can have long-term effects on many organs in the body
Bilateral pleural effusion
Left lower lobe lung collapse
Pleural effusion: excess Accumilation of fluid between two pleural layers fluid-filled space that surrounds the lungs.
Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation.
In non-hodgkin the tumor develops in lymphocytes
Widespread disease the lymphoma has spread (metastasized) via the bloodstream to organs outside the lymph system, such as the bone marrow, brain, skin, or liver.