Diagnostic Radiology/Chest Imaging/Pulmonary Nodules
- State the definition of a solitary pulmonary nodule and a pulmonary mass
- Name the three most common causes of a solitary pulmonary nodule
- Name four important considerations in the evaluation of a solitary pulmonary nodule
- Name six causes of cavitary pulmonary nodules
- Name four causes of multiple pulmonary nodules
- State the indications for percutaneous biopsy of a solitary pulmonary nodule
- State the indications for percutaneous biopsy when there are multiple pulmonary nodules
- State the complications and the frequency with which complications occur due to percutaneous lung biopsy using CT or fluoroscopic guidance
- State the indications for chest tube placement as a treatment for pneumothorax related to percutaneous lung biopsy
- State the role of positron emission tomography (PET) in the evaluation of a solitary pulmonary nodule
Work up of new or enlarged solitary pulmonary nodule (SPN) in Chest X-ray or SPN on CT
Perform a High Resolution CT-scan (HRCT) study
- Benign calcification or shape: No further work-up is indicated.
- Fat (with or without calcification) : No further work-up is indicated.
- 4–10 mm: Follow up with CT volumetrics studies in 6, 12, and 24 months.
- >10 mm:
- ground glass opacity with or without a solid lesion: biopsy/resect
- solid: CT with IV contrast, PET, or Biopsy
- In contrast CT, malignant lesions show an increase of greater than 15H after contrast (98% sensitive for 6-30 mm nodules)
- PET with Fluorine-18-labeled fleurodeoxyglucose is 97% sensitive, and 78% specific for nodules that are larger than 10 mm
- if negative: follow up in 6, 12, and 24 months
Doubling time (volume) of less than one month or longer than two years suggest a benign lesion.