9.9: Solitary Lung Nodule

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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

Figure 9.24A PA Chest x-ray displaying a solitary lung nodule

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.