Lung Nodules and Masses Flashcards
What is a solitary pulmonary nodule?
A lesion that is both within and surrounded by pulmonary parenchyma
T or F: most lung masses (>3 cm) are malignant
T
What are causes of
Malignant (20-50%)
Benign (50-80%)
Are are some malignant causes?
Bronchogenic carcinoma Adenocarcinoma Squamous cell carcinoma Large cell carcinoma Small cell carcinoma
Metastatic lesions Breast Head and neck Melanoma Colon Kidney Sarcoma Germ cell tumor Others
Pulmonary carcinoid
What are some benign causes?
Infectious granuloma
Histoplasmosis, Coccidioidomycosis, Cryptococcosis, Blastomycosis, Tuberculosis, Atypical mycobacteria
Other infections
Bacterial abscess, Dirofilaria immitis, Echinococcus cyst, Ascariasis, Pneumocystis cariniii, Aspergilloma
Benign neoplasms
Hamartoma, Lipoma, Fibroma
Vascular
Arteriovenous malformation, Pulmonary varix
Developmental
Bronchogenic cyst
Inflammatory
Granulomatosis with polyangiitis (Wegener’s), Rheumatoid nodule
Other
Amyloidoma, Rounded atelectasis, Intrapulmonary lymph nodes, Hematoma, Pulmonary infarct, Pseudotumor (loculated fluid), Mucoid impaction
What is expected in lung hyperinflation?
Hoover’s sign refers to the inspiratory retraction of the lower intercostal spaces
- Diaphragmatic excursion
- Barrel Chesting (AP diameter is 0.7) - rounded chest
- reduced laryngeal height
Which value tells the degree/severity of COPD?
FEV1
What are the risks that nodules are malignant?
Increasing age (>35)
Prior pulmonary disease (especially COPD)
History of tobacco exposure
- Quantity smoked
- Second-hand smoke exposure
Exposure to other carcinogens (ie.asbestos)
History of cancer (thoracic or extra-thoracic)
What clues from history would suggest benign disease?
History of tuberculosis or fungal infection
(ie. coccidiomycosis, histoplasmosis)
Travel to or residence in areas where exposure to the above organisms is likely
Previously identified benign disease on imaging
What would suggest from imaging benign vs. malignant?
Size of the nodule (bigger the higher it is malignant)
Doubling time (time for volume to double)
Margin characteristics
Density (solid vs sub-solid)
Calcification patterns
What is usually the doubling time for malignant lesions?
30-400 days
What would suggest benign with respect to doubling time?
A lesion is more likely benign if:
Doubling time < 20 - 30 days or,
Stable in size for > 2 years or,
Volume of lesion decreases over time
What are typical margin characteristics for malignant nodules?
The risk of malignancy increases with lobulated, irregular and spiculated (corona radiata) margins
Which type of nodule density has the highest risk of malignancy?
Solid»_space; part-solid > ground glass
What type of calcifications are related to increased risk of malignancy?
strippled or eccentric
