Izolovana metastaza karcinoma pluća u kostima ručja

  • Milan S Stanković University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Clinical Center of Vojvodina, †Clinic for Orthopaedic Surgery and Traumatology, Novi Sad, Serbia; Community Health Center, Novi Sad, Serbia
  • Ivica R Lalić University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Clinical Center of Vojvodina, †Clinic for Orthopaedic Surgery and Traumatology, Novi Sad, Serbia; Community Health Center, Novi Sad, Serbia
  • Aleksandar P Đuričin University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Clinical Center of Vojvodina, †Clinic for Orthopaedic Surgery and Traumatology, Novi Sad, Serbia; Community Health Center, Novi Sad, Serbia
  • Nemanja M Gvozdenović University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Clinical Center of Vojvodina, †Clinic for Orthopaedic Surgery and Traumatology, Novi Sad, Serbia; Community Health Center, Novi Sad, Serbia
DOI: https://doi.org/10.2298/VSP151126296S
Ključne reči: bone neoplasms||, ||kosti, neoplazme, neoplasm metastasis wrist joint||, ||neoplasme, metastaze ručje, zglob, carpal bones||, ||karpusne kosti, lung neoplasms||, ||pluća, diagnosis||, ||dijagnoza, treatment outcome||, ||lečenje, ishod,

Sažetak


Uvod. Karcinom pluća obično daje metastaze u skeletni sistem, od kojih 0,1% u predeo ručnog zgloba, a od tog broja samo 17% otpada na kosti ručja. Prikazan je bolesnik sa odloženom dijagnozom izolovane metastaze karcinoma pluća retke lokalizacije u kostima ručja, sa nadlakatnom amputacijom kao krajnjim ishodom. Prikaz bolesnika. Bolesnik starosti 56 godina, fizički radnik, zdrav, “teški pušač”, sa kašljem tokom decenija uz povremeno iskašljavanje i promuklost, poslednja tri meseca žalio se na bol u  desnom ručnom zglobu. Bolesnik je negirao traumu. Na osnovu kliničkog pregleda postavljena je dijagnoza zapaljenja tetiva šake (dijagnoza fizijatra) i odmah je započeta fizikalna terapija. Nakon završetka fizikalne terapije, simptomi su se delimično smirili, ali je ubrzo došlo do pogoršanja stanja u smislu pojave simptoma kompresije medijalnog živca (nervus medijanus). Bolesnik je poslat na dalje lečenje neurologu, koji je postavio dijagnozu sindroma karpalnog tunela. Stanje bolesnika se pogoršavalo zbog čega je upućen u Urgentni centar Kliničkog Centra Vojvodine, Novi Sad, sa uputnom dijagnozom zapaljenja ručnog zgloba. Konačna dijagnoza izolovane metastaze adenokarcinoma pluća postavljena je biopsijom i pregledom onkologa. Primarna lokalizacija tumora pluća dijagnostikovana je kompjuterizovanom tomografijom i scintigrafijom skeleta.  Načinjena je visoka amputacija ruke i bolesnik je poslat na dalje lečenje onkologu. Zaključak. Pažljivo uzeta anamneza, detaljan opšti i lokalni klinički pregled i učestalije kontrole bolesnika mogu pomoći u postavljanju tačne dijagnoze tumora pluća, pre širenja procesa i nastanka težih komplikacija.

Biografije autora

Milan S Stanković, University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Clinical Center of Vojvodina, †Clinic for Orthopaedic Surgery and Traumatology, Novi Sad, Serbia; Community Health Center, Novi Sad, Serbia
Srbija
Ivica R Lalić, University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Clinical Center of Vojvodina, †Clinic for Orthopaedic Surgery and Traumatology, Novi Sad, Serbia; Community Health Center, Novi Sad, Serbia
Asistent
Aleksandar P Đuričin, University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Clinical Center of Vojvodina, †Clinic for Orthopaedic Surgery and Traumatology, Novi Sad, Serbia; Community Health Center, Novi Sad, Serbia
Doktor
Nemanja M Gvozdenović, University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Clinical Center of Vojvodina, †Clinic for Orthopaedic Surgery and Traumatology, Novi Sad, Serbia; Community Health Center, Novi Sad, Serbia
Asistent

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Objavljeno
2017/11/28
Broj časopisa
Vol. 74 Br. 11 (2017)
Rubrika
Prikaz bolesnika