Lung nodules Flashcards
Define lung nodule
discrete area of increased density within lung parenchyma
- can be solid or ground-glass
- usually has defined border
- solitary/multiple/innumerable
What does ground-glass lung nodule mean?
intermediate between solid and air density
Lung nodule size
<30mm
Lung mass size
> 30mm
Indications for chest imaging for inpatients
heart failure/pulmonary oedema
checking of lines/tubes
infections/pneumonia/?mass
Indications for chest imaging for outpatients
monitoring of chronic lung disease eg. fibrosis, sarcoidosis
Indications for chest imaging in ED
chest pain
?pneumonia
Indications for chest imaging for GP referrals
cough or haemoptysis
systemic symptoms eg. weight loss
Benign lung nodules differentials
intrapulmonary lymph nodes
sarcoidosis
vasculitis (eg. GPA)
tuberculoma
infection
benign tumours (eg. hamartoma)
Malignant lung nodules differentials
primary lung malignancy
metastasis (common: breast, colon, head + neck, renal cell, testicular)
How should lung nodules <5mm be followed up?
no follow up
How should lung nodules 5-8mm be followed up?
follow up for 2 years (solid nodules), or 4 years (sub-solid/ground-glass nodules)
stable = discharge
enlarging = further work up/definitive management
How should lung nodules >8mm be followed up?
assess risk score (Brock model)
<10% = CT follow up
10-70% = consider biopsy/excision/surveillance
>70% = consider excision
Where are intrapulmonary lymph nodes normally seen and what do they look like?
majority in lower lobes, below level of carina
normally within 20mm of visceral pleural surface
triangular/polygonal/oval
solid, sharp border
attached to visceral pleura or fissure or centred on an interlobular septum
no malignant potential
no follow up recommended
