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9.9: Solitary Lung Nodule

  • Page ID
    14841
  • ACR – Chest – Radiographically Detected Solitary Pulmonary Nodule

    Case

    Incidental, Solitary Pulmonary Nodule

    Clinical:

    History – As part of a General Physical Exam, a routine chest x-ray was ordered on this 53 year old male. His last physical examination was 3 years ago. Chronic smoker. Mild COPD. Insulin dependent diabetic.

    Symptoms – Dry cough, mild chronic dyspnea. Nil acute.

    Physical – Non-contributory.

    DDx:

    Routine screening, smoker.

    Solitary pulmonary nodule detected.

    Imaging Recommendation

    ACR – Chest – Radiographically Detected Solitary Pulmonary Nodule, Variant 1

    Chest X-ray

    CT Chest without and with IV contrast

    ODIN Link for Chest x-ray images, Figure 9.24A and B: mistr.usask.ca/odin/?caseID=20170202123906863 ODIN Link for Chest CT images, 9.24: mistr.usask.ca/odin/?caseID=20170202131226013
    chest-case-11-2-1.jpg
    Figure 9.24A PA Chest x-ray displaying a solitary lung nodule
    chest-case-11-3-766x1024.jpg
    Figure 9.24B Lateral Chest x-ray demonstrating a solitary pulmonary nodule

    Imaging Assessment

    Findings:

    There were changes of mild COPD. A 2.5 – 3 cm diameter, circumscribed, opacity was seen in the right lower lobe. The opacity overlapped the right hilum and the thoracic spine. No other findings.

    Interpretation:

    Solitary pulmonary nodule. This abnormality was suspicious for a malignancy. CT of the chest was recommended for further assessment. If concern persists for malignancy after this examination an imaging guided needle biopsy of the lung nodule should be considered.

    Diagnosis:

    Solitary Pulmonary Nodule – Suspicious for Malignancy

    Discussion:

    A nodule is defined as a circumscribed opacity < 3 cm in diameter. The differential is broad. There are imaging features that suggest benignity, while for others there are imaging features that require imaging follow-up or biopsy.

    The Fleischner Society has established nodule follow-up guidelines:

    fleischnersociety.org

    X-ray findings may include:

    • A nodule or mass is an opacity with smooth or lobulated margins.
    • The margins of the nodule or mass may be smooth, lobulated, or spiculated.
    • There may be calcification in the nodule or mass.
    • Masses may grow to invade the pleura, chest wall, hilum, mediastinum, and may cross fissures.
    • The mass may have adenopathy or pleural effusion associated with it.

    Attributions

    Figure 9.24A PA Chest x-ray displaying a solitary lung nodule by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.

    Figure 9.24B Lateral Chest x-ray displaying a solitary lung nodule by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.

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