A change in the character of the regular cough of a smoker old male, particularly if it is associated with other new respiratory symptoms, should raise the possibility of bronchogenic carcinoma.I-Thoracic manifestations of Bronchogenic carcinoma A- Bronchopulmonary presentations: 1- Asymptomatic (detected accidentally by routine x-ray as coin shadow) 2- Cough and haemoptysis : Blood tinged sputum - Red current jelly i.e. sputum consist of Mucous, Tissue debris, RBCs 3- Bronchial obstruction • Partial ==> Emphysema , Bronchiectasis • Complete ==> Lung collapse 4- Pneumonia usually recurrent at the same site, or is slow to respond to treatment. 5- Lung abscess (due to secondary infection) 6- Thoracic inlet syndrome may occur due to bronchial carcinoma in the apex of the lung (superior sulcus tumour) causing invasion of : • Upper 3 ribs • Sympathetic chain ===> Horner syndrome - Ipsilateral partial ptosis. - Ipsilateral enophthalmos and a small pupil - Ipsilateral hypohidrosis of the face. • SVC obstruction (congested non pulsating neck veins) • Lower trunk of brachial plexus (Pancoast's syndrome) : - Pain in shoulter and inner - Wasting of the smal1 muscles of the hand • Subclavian artery ===> unequal pulse volume in both upper limbs . 7- Cor pulmonale due to lymphangitis carcinomatosa. B - Pleural presentations: * Effusion : • Malignant effusion (Exudate) : Massive ,Hemorrhagic, Rapidly re-accumulating • Transudate : due to obstruction of azygos vein . • Chylous : due to obstruction of the thoracic duct . • Empyema : due to rupture of malignant abscess into pleura . * Dry pleurisy may occur C - Mediastinal presentations: Mediastinal spread may result in dysphagia . • Hypercalcemia is usually caused by squamous cell carcinoma. • Syndrome of inappropriate ADH and ectopic ACTH seretion are usually associated with small cell carcinoma. • Clubbing most often with non small cell carcinoma. • Gynecomastia is usually with large cell carcinoma. • Hypertrophic pulmonary osteoarthropathy is usually with adenocarcinoma. • Neurological syndromes may occur with any type of bronchial carcinoma.II- Extra-thoracic manifestations of Bronchogenic carcinoma : Source : Manifestations of Bronchogenic carcinoma
