9.9: Solitary Lung Nodule
- Page ID
- 14841
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\(\newcommand{\avec}{\mathbf a}\) \(\newcommand{\bvec}{\mathbf b}\) \(\newcommand{\cvec}{\mathbf c}\) \(\newcommand{\dvec}{\mathbf d}\) \(\newcommand{\dtil}{\widetilde{\mathbf d}}\) \(\newcommand{\evec}{\mathbf e}\) \(\newcommand{\fvec}{\mathbf f}\) \(\newcommand{\nvec}{\mathbf n}\) \(\newcommand{\pvec}{\mathbf p}\) \(\newcommand{\qvec}{\mathbf q}\) \(\newcommand{\svec}{\mathbf s}\) \(\newcommand{\tvec}{\mathbf t}\) \(\newcommand{\uvec}{\mathbf u}\) \(\newcommand{\vvec}{\mathbf v}\) \(\newcommand{\wvec}{\mathbf w}\) \(\newcommand{\xvec}{\mathbf x}\) \(\newcommand{\yvec}{\mathbf y}\) \(\newcommand{\zvec}{\mathbf z}\) \(\newcommand{\rvec}{\mathbf r}\) \(\newcommand{\mvec}{\mathbf m}\) \(\newcommand{\zerovec}{\mathbf 0}\) \(\newcommand{\onevec}{\mathbf 1}\) \(\newcommand{\real}{\mathbb R}\) \(\newcommand{\twovec}[2]{\left[\begin{array}{r}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\ctwovec}[2]{\left[\begin{array}{c}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\threevec}[3]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\cthreevec}[3]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\fourvec}[4]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\cfourvec}[4]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\fivevec}[5]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\cfivevec}[5]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\mattwo}[4]{\left[\begin{array}{rr}#1 \amp #2 \\ #3 \amp #4 \\ \end{array}\right]}\) \(\newcommand{\laspan}[1]{\text{Span}\{#1\}}\) \(\newcommand{\bcal}{\cal B}\) \(\newcommand{\ccal}{\cal C}\) \(\newcommand{\scal}{\cal S}\) \(\newcommand{\wcal}{\cal W}\) \(\newcommand{\ecal}{\cal E}\) \(\newcommand{\coords}[2]{\left\{#1\right\}_{#2}}\) \(\newcommand{\gray}[1]{\color{gray}{#1}}\) \(\newcommand{\lgray}[1]{\color{lightgray}{#1}}\) \(\newcommand{\rank}{\operatorname{rank}}\) \(\newcommand{\row}{\text{Row}}\) \(\newcommand{\col}{\text{Col}}\) \(\renewcommand{\row}{\text{Row}}\) \(\newcommand{\nul}{\text{Nul}}\) \(\newcommand{\var}{\text{Var}}\) \(\newcommand{\corr}{\text{corr}}\) \(\newcommand{\len}[1]{\left|#1\right|}\) \(\newcommand{\bbar}{\overline{\bvec}}\) \(\newcommand{\bhat}{\widehat{\bvec}}\) \(\newcommand{\bperp}{\bvec^\perp}\) \(\newcommand{\xhat}{\widehat{\xvec}}\) \(\newcommand{\vhat}{\widehat{\vvec}}\) \(\newcommand{\uhat}{\widehat{\uvec}}\) \(\newcommand{\what}{\widehat{\wvec}}\) \(\newcommand{\Sighat}{\widehat{\Sigma}}\) \(\newcommand{\lt}{<}\) \(\newcommand{\gt}{>}\) \(\newcommand{\amp}{&}\) \(\definecolor{fillinmathshade}{gray}{0.9}\)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
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.