Pulmonary Nodules And Cavities

Question 0

What features in clinical history may aid the diagnosis of a cavity

Answer 0

Duration: short infection. Long cancer
Fever etc: infection
Recent flight: pulmonary infarct

Previous Ca
Trauma
Immunosuppresion
Countries

Question 1

How may the morphology of cavities vary

Answer 1

Thick and thin walled
Smooth or irregular walled
Mass or fluid
Exist in area of pneumonia

Question 2

Feature of benign and malignant cavities

Answer 2

Benign: thin walled smooth
Malignant: thick walled irregular

Question 3

Common infective causes of cavities

Answer 3

Reactivation TB
Bacterial
      Staph/Klebsiella
Rare
  Fung. Hydatid. Aspiration pneumonia.

Question 4

Commonests cavitating malignant lesion

Answer 4

Squamous cell tumours

Question 5

What should you look for in trauma cavities

Answer 5

Overlying blunt force trauma. Causing haematoma. Rib fractures

Question 6

Vascular cause of cavities

Answer 6

Pulmonary embolism

Septic emboli

Question 7

Inflammatory lesions causing cavities

Answer 7

Wegeners
Rheumatoid
Sarcoidosis
PMF

Question 8

Clues to finding the cause of cavitating lesions

Answer 8

Pleura: effusion/nodules -> malignancy
Lungs: tree in bud ->TB / air crescent, fungal. Parenchymal disease of CVD.
Mediastinum: lymph. Malignancy
Pulmonary arteries: PE
Bones: trauma. Lytic or sclerotic malignancy
Joints
Liver/Adrenals: mets

Question 9

Cavity mimics

Answer 9

Dilated bronchiectasis
Hiatus hernia
Fibrosis
Bullae

Question 10

Definition of a nodule

Answer 10

Spherical lung opacity measuring less than 3cm in diameter

Question 11

Important features in history when assessing multiple pulmonary nodules

Answer 11

Immunocompromised : opportunistic 
Primaries 
Other symptoms : infective 
Occupational history
Smoker

Question 12

Causes of MPN in immunocompromised patients

Answer 12

Opportunistic infection: Aspergillosis
HIV lymphoma
Kaposis

Question 13

Causes of multiple pulmonary nodules in immunocompetent

Answer 13

Malignant: pul mets. Bronchioalveolar cell carcinoma
Infective: septic emboli. TB
Vascular: infarcts
Granulomas : sarcoidosis. Wegeners. Rheumatoid
Pneumoconiosis: silicosis coal workers lung. Asbestosis
Congenital : AV malformations

Question 14

Classic radiological features to aid diagnosis of MPNS

Answer 14

Size and number: military 
Cavitation: non specific 
Calcification: hamatoma TB some mets
Margins: sharp. Mets
Growth rate: double time  2 years = benign 
Lymphadenopathy

Question 15

Distribution of diffuse small nodules

Answer 15

Perilymphatic
Subpleural. Peribronchivascular.
( sarcoidosis. Lymphangitis. Silicosis)

Inter lobular.

Random
Miliary mets and TB

Centrilobular
Tree in bud -> Bronchiolitis. cystic fibrosis. ABPA

Question 16

Causes of larger masses and opacities

Answer 16

Cannonball mets : breast colon kidney uterus head neck

Rheumatoid nodule

Wegeners