Mesothelioma Goodpastures and Wegners Flashcards
What is a mesothelioma
Tumour of mesothelial cells that usually occurs in the pleura. (rarely in peritoneum or other organs)
Is associated with asbestos exposure
Prognosis is poor
Clinical presentation of mesothelioma?
similar to other lung cancer with significant pleural effusions and chest pain
Diagnostic tests and results for a mesothelioma?
CXR and CT will show pleural thickening and effusion
Blood and pleural fluid analysis
Diagnosis made on histology following thoracoscopy
Treatment for a mesothelioma?
Chemotherapy (cisplatin and premetrexed)
Premetrexed also used for NSCLC
Cisplatin also used for SCLC
What is Goodpastures syndrome?
A pulmonary renal syndrome.
Auto-immune disease caused by anti-glomerula basement membrane antibodies.
Same antibodies also attack alveolar basement membrane,
Clinical presentation of Goodpastures syndrome?
Acute glomerular nephritis
Lung symptoms: Haemoptysis and diffuse pulmonary haemorrhage
May present with shock
Diagnostic tests and results for Goodpastures?
CXR will show infiltrates due to pulmonary haemorrhage in lower zones
Kidney biopsy
Treatment for Goodpastures?
Vigorous immunosuppressive treatment (corticosteroids)
Plasmapharesis (exchange of plasma)
Treat shock
Wegner’s granulomatosis/ granulomatosis with polyangitis
What is it?
Multi-system disorder of unknown cause
Necrotising granulomatous inflammation and vasculitis of small and medium sized vessels
Most commonly affected upper respiratory tract, lungs and kidneys
Clinical presentation of wegner’s granulomatosis is widespread, how does it present in upper respiratory tract?
Nasal obstruction, ulcers, epistaxis (nose bleed) or destruction of the nasal septum – ‘saddle-nose’ deformity
Sinusitis
Clinical presentation of wegner’s granulomatosis is widespread, how does it present with renal symptoms?
Pulmonary symptoms?
Rapidly progressive glomerulonephritis with crescent formation
Proteinuria and haematuria
Cough, Haemoptysis, Pleuritis
Clinical presentation of wegner’s granulomatosis is widespread. What non pulmonary, upper respiratory tract or renal symptoms may present?
Skin purpura or nodules Peripheral neuropathy Mononeuritis multiplex Arthritis/arthralgia Ocular involvement
Diagnostic tests for wegner’s?
Blood test,
Urinalysis
CXR and CT
What blood test results would suggest wegner’s?
cANCA (cytoplasmic Anti Nuclear Cytoplasmic Antibodies) are raised in most patients
Raised ESR and CRP
What urinalysis results would suggest wegner’s?
Proteinuria, haematuria
If present, renal biopsy
