Male/45 yr Came with complains of : 1. Cough with sputum - 2 months 2. Fever - 1 month 3. Chest pain - 1 month 4. Breathlessness- 1 month On examination : # a swelling is found on right lateral side of neck. 4-5 cm Which was hard , non tender , above the muscles , non pulsating and dont move with swallowing. Similar swelling is seen on left side of neck but 1-1.5 cm near angle of mandible. #The trache is deviated to left side. On percussion :- stony Dull notes are found in infrascapular and interscapular region. #Liver dullness is on 5th ICS There is h/o wt loss ,loss of appetite , muscle weakness. Pt is smoker ( 30 packs/yr) What can be Differential diagnosis..? How to manage ?




This is probably a ca lung with supra clavicular mets. Go for pleural fluid cell block cytology ,protein,sugar,LDH,ADA. And a cect thorax with trucyt biopsy of SOL if any. Usg neck to c the thyroid and FNAC of lymph node to be done. If pleural fluid cell block is positive for malignant pleural effusion then u will need a immuno histochemistry. Shudnt do therapeutic thoracocentesis until distress develops. This isnt a massive pleural effusion

Thank you sir!

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Hard,fixed,painless swelling in right supraclavicular area in a smoker with loss of appetite.waite,and massive pleural effusion right side will go in favor of malignancy may be pancoast tumor right Apex(which is not showing in x-ray) Biopsy from swelling,CT scan chest and pleural fluid analysis will guide the diagnosis.Treatment would be according reports.Needs repeated aspirations.(Tuberculosis, secondaries from upper G.I., Stomach are included in D/D)

@Dr. Syam Sundar Patro @Curofy @Pakhi Mittal @Dr. Vimal Modi @Dr. Khalil Dhanshe @Ashwani Jain @Dr. Javaid Iqbal Khan

Right sided Pleural Effusion. Thyroid Malignancy. FNAC of the Swelling Retrosternal. Pleural Tap & look for routine Look for Malignant cells in the Pleural aspirate. Therapeutic drainage of pleural effusion.. Look for Primary pulmonary Tuberculosis.

Okay.. Thnkew sir!

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DD:Pulmonary tuberculosis Metastasis to lymph node Investigation:USG neck, FNAC node, Sputum AFB, CBC,RFT, PET CT, USG abdomen Rx:Proceed after FNAC reports mam. If It's Pulmonary TB,Start ATT.

Thnkew mam!

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Massive pleural effusion , go for laryngoscopy to rule out glottic carcinoma , fnac of swelling , afb sputum , mediastinal ct to look for other soft tissues , thoracocentesis !

K.. Thnks

Biopsy from the neck mass with IHC and CECT thorax and neck .If lung primary is suspected , CT thorax n Biopsy /IHC will be complimentary to each other for the diagnosis .

Ok thank you sir.

ca lung with right sided pleural effusion with mets in neck; go for fnac of neck swellings and diagnostic aspiration to look for malignant cells

Okay mam thank you.

I agree with vaibhav kajaria To me also it looks that it is primarily a case of CA lung with EFF rt side with mets in neck

Thnkew sir!

FNA of supraclavicular node, pleural tap, CT Chest and Abdomen. Most likely a case of Ca right lung.

Ok sir thnkew!
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