Lung mass imaging: Difference between revisions
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==Overview== | ==Overview== | ||
[[CT scan]] is the method of choice for | [[CT scan]] is the method of choice for [[imaging]] of lung mass. On [[imaging]], the evaluation of lung mass will depend on several characteristics, such as [[calcification]], margins, location, distribution, and [[attenuation]]. Further evaluation of lung mass should include other [[diagnostic]] studies such as [[bronchoscopy]], [[sputum]] [[cytology]], or [[mediastinoscopy]]. For [[occult]] [[disease]] and assessment of [[malignancy]], additional [[Test|tests]] such as [[PET scan]] may also be done. | ||
==Imaging== | ==Imaging== | ||
On imaging, lung mass can be divided into two categories | On [[imaging]], lung mass can be divided into the following two categories:<ref name="pmid19835344">{{cite journal |vauthors=Albert RH, Russell JJ |title=Evaluation of the solitary pulmonary nodule |journal=Am Fam Physician |volume=80 |issue=8 |pages=827–31 |year=2009 |pmid=19835344 |doi= |url=}}</ref> | ||
'''1. Hyperdense Pulmonary Mass''' | |||
*Hyperdense pulmonary mass is defined as a pulmonary mass with internal [[calcification]]. | *Hyperdense pulmonary mass is defined as a pulmonary mass with internal [[calcification]]. | ||
*The most common causes of hyperdense pulmonary mass are [[granuloma]] (most common), pulmonary [[hamartoma]], [[bronchogenic carcinoma]], [[carcinoid tumors]], and pulmonary [[Metastasis|metastases]]. | *The most common causes of hyperdense pulmonary mass are [[granuloma]] (most common), [[Lung|pulmonary]] [[hamartoma]], [[bronchogenic carcinoma]], [[carcinoid tumors]], and [[Lung|pulmonary]] [[Metastasis|metastases]]. | ||
'''Cavitating | '''2. Cavitating Pulmonary Mass''' | ||
*Cavitating pulmonary mass is defined as a gas-filled area of the lung in the center of a [[nodule]], mass or area of [[Consolidation (medicine)|consolidation]]. | *Cavitating pulmonary mass is defined as a [[gas]]-filled area of the [[lung]] in the center of a [[nodule]], mass, or area of [[Consolidation (medicine)|consolidation]]. | ||
*Cavitating pulmonary mass is also characterized by a thick wall (must be greater than 2-5 mm). | *Cavitating pulmonary mass is also characterized by a thick wall (must be greater than 2 - 5 mm). | ||
*The most common causes of cavitating pulmonary mass | *The most common causes of cavitating pulmonary mass include [[malignancies]], [[infections]], [[inflammation]] processes, and [[congenital malformations]]. | ||
* The table below summarizes the most common causes of cavitating pulmonary mass | * The table below summarizes the most common causes of cavitating pulmonary mass: | ||
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center" | {| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center" | ||
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! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|'''Description'''}} | ! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|'''Description'''}} | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Malignancy | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Cancer|Malignancy]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Primary [[bronchogenic carcinoma]] (especially [[squamous cell carcinoma]]) | |||
*Primary bronchogenic carcinoma(especially squamous cell carcinoma) | *Cavitating [[Pulmonary metastasis|pulmonary metastases]] (especially [[squamous cell carcinoma]], [[Gastrointestinal tract|gastrointestinal]] [[adenocarcinoma]], [[sarcoma]]) | ||
*Cavitating pulmonary metastases (especially squamous cell carcinoma, | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Thick wall | *Thick wall | ||
*Irregular shape | *Irregular shape | ||
* | *Causes distortion of adjacent structures | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Infection | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Infection]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Pulmonary bacterial abscess/cavitating pneumonia | *Pulmonary [[Bacteria|bacterial]] [[abscess]]/cavitating [[pneumonia]] | ||
*Empyema | *[[Empyema]] | ||
*Post-pneumonic | *Post-[[Pneumonia|pneumonic]] [[pneumatocele]] | ||
*Septic pulmonary emboli | *[[Sepsis|Septic]] [[Pulmonary embolism|pulmonary emboli]] | ||
*Pulmonary coccidioidomycosis | *[[Lung|Pulmonary]] [[coccidioidomycosis]] | ||
*Pulmonary actinomycosis / thoracic actinomycosis | *[[Lung|Pulmonary]] [[actinomycosis]]/[[Chest|thoracic]] [[actinomycosis]] | ||
*Pulmonary nocardiosis | *[[Lung|Pulmonary]] [[nocardiosis]] | ||
*Melioidosis | *[[Melioidosis]] | ||
*Pulmonary cryptococcosis | *[[Lung|Pulmonary]] [[cryptococcosis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
Abscess: | '''Abscess''': | ||
*Round in all projections | *Round in all projections | ||
*Abruptly interrupts bronchovascular structures | *Abruptly interrupts bronchovascular structures | ||
*May form | *May form an acute angle with the [[costal]] surface/[[chest wall]] | ||
*Abscesses have thick irregular walls | *[[Abscess|Abscesses]] have thick irregular walls | ||
*Abscesses usually have an acute angle (claw sign) | *[[Abscess|Abscesses]] usually have an acute angle (claw sign) | ||
Empyema: | |||
'''Empyema''': | |||
*Smoother margins | *Smoother margins | ||
*Lentiform shape | *Lentiform shape | ||
*Distort and compresses adjacent lung | *Distort and compresses adjacent [[lung]] | ||
* | *[[Empyema]] has obtuse angles | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | | ||
Non-infectious | Non-infectious | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Granulomatosis with polyangitis | *[[Granulomatosis with polyangiitis|Granulomatosis with polyangitis]] | ||
*Rheumatoid nodules | *[[Rheumatoid nodule|Rheumatoid nodules]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*May be single or multiple | *May be single or multiple | ||
*Size ranges from 0.5-7 cm | *Size ranges from 0.5 - 7 cm | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | | ||
Vascular | [[Vascular]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Consolidation with internal air lucencies | *[[Pulmonary infarction|Pulmonary infarct]] | ||
*"Bubbly consolidation"; this | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*[[Consolidation (medicine)|Consolidation]] with internal air lucencies | |||
*"Bubbly [[Consolidation (medicine)|consolidation]]"; this represents non-[[Infarction|infarcted]] aerated [[lung]] [[parenchyma]] | |||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | | ||
Trauma | [[Physical trauma|Trauma]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* | *[[Pneumatocele|Pneumatoceles]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Smooth inner margins | *Smooth inner margins | ||
*Contain little if any fluid | *Contain little if any [[fluid]] | ||
*Wall (if visible) is thin and regular | *Wall (if visible) is thin and regular | ||
*Persist despite absence of | *Persist despite absence of [[Symptom|symptoms]] | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Congenital | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Congenital disorder|Congenital]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Congenital cystic adenomatoid malformation (CCAM) | *[[Congenital cystic adenomatoid malformation|Congenital cystic adenomatoid malformation (CCAM)]] | ||
*Pulmonary sequestration | *[[Pulmonary sequestration]] | ||
*Bronchogenic cyst | *[[Bronchogenic cyst]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Radiological features vary according to disease | *[[Radiological]] features vary according to the [[disease]] | ||
|} | |} | ||
==Imaging Evaluation== | ==Imaging Evaluation== | ||
The evaluation of lung mass | The evaluation of lung mass depends on the following 5 characteristics:<ref name="pmid7208937">{{cite journal |vauthors=Kundel HL |title=Predictive value and threshold detectability of lung tumors |journal=Radiology |volume=139 |issue=1 |pages=25–9 |year=1981 |pmid=7208937 |doi=10.1148/radiology.139.1.7208937 |url=}}</ref><ref name="pmid21697415">{{cite journal |vauthors=Hochhegger B, Marchiori E, Sedlaczek O, Irion K, Heussel CP, Ley S, Ley-Zaporozhan J, Soares Souza A, Kauczor HU |title=MRI in lung cancer: a pictorial essay |journal=Br J Radiol |volume=84 |issue=1003 |pages=661–8 |year=2011 |pmid=21697415 |pmc=3473490 |doi=10.1259/bjr/24661484 |url=}}</ref> | ||
* '''Calcification:''' [[Calcification]] patterns are commonly seen in [[granulomatous]] disease and [[hamartomas]]. They are normally a sign of [[benign]] lung mass. The characteristic [[benign]] calcification patterns of lung mass | * '''Calcification:''' [[Calcification]] patterns are commonly seen in [[granulomatous]] [[disease]] and [[hamartomas]]. They are normally a sign of [[benign]] lung mass. The characteristic [[benign]] [[calcification]] patterns of lung mass include: | ||
**[[Diffuse]] | **[[Diffuse]] | ||
**[[Central]] | **[[Central]] | ||
**Laminated | **Laminated | ||
**[[Popcorn lung disease|Popcorn]] | **[[Popcorn lung disease|Popcorn]] | ||
* '''Size:''' Any area of pulmonary opacification that measures more than 30 mm ( | * '''Size:''' Any area of [[Lung|pulmonary]] opacification that measures more than 30 mm (3 cm) has to be evaluated to determine the [[histology]] of the [[Tissue (biology)|tissue]]. | ||
* '''Location:''' Common | * '''Location:''' Common locations of lung mass are [[pleural]], endobronchial, and [[parenchymal]]. | ||
* '''Margins:''' The different types of margins for lung mass include lobulated or scalloped margins and smooth margins. The lobulated or scalloped margins are associated with intermediate [[malignancy]] probability whereas smooth margins are associated with [[benign]] nature of lung mass. | * '''Margins:''' The different types of margins for lung mass include [[Lobule|lobulated]] or scalloped margins and smooth margins. The [[Lobule|lobulated]] or scalloped margins are associated with intermediate [[malignancy]] probability whereas smooth margins are associated with [[benign]] nature of lung mass. | ||
* '''Attenuation:''' Lung mass may have different types of [[attenuation]]. Common types of [[attenuation]] are [[solid]] ([[malignancy]] rate of only 7%), [[Calcified lesion|calcified]], partly solid ([[malignancy]] rate of 63%), and [[Ground glass opacification on CT|ground glass]] ([[malignancy]] rate of 18%). | * '''Attenuation:''' Lung mass may have different types of [[attenuation]]. Common types of [[attenuation]] are [[solid]] ([[malignancy]] rate of only 7%), [[Calcified lesion|calcified]], partly solid ([[malignancy]] rate of 63%), and [[Ground glass opacification on CT|ground glass]] ([[malignancy]] rate of 18%). | ||
Latest revision as of 17:34, 21 June 2019
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Lung Mass Microchapters |
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Diagnosis |
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Treatment |
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Lung mass imaging On the Web |
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American Roentgen Ray Society Images of Lung mass imaging |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2] Akshun Kalia M.B.B.S.[3]
Overview
CT scan is the method of choice for imaging of lung mass. On imaging, the evaluation of lung mass will depend on several characteristics, such as calcification, margins, location, distribution, and attenuation. Further evaluation of lung mass should include other diagnostic studies such as bronchoscopy, sputum cytology, or mediastinoscopy. For occult disease and assessment of malignancy, additional tests such as PET scan may also be done.
Imaging
On imaging, lung mass can be divided into the following two categories:[1]
1. Hyperdense Pulmonary Mass
- Hyperdense pulmonary mass is defined as a pulmonary mass with internal calcification.
- The most common causes of hyperdense pulmonary mass are granuloma (most common), pulmonary hamartoma, bronchogenic carcinoma, carcinoid tumors, and pulmonary metastases.
2. Cavitating Pulmonary Mass
- Cavitating pulmonary mass is defined as a gas-filled area of the lung in the center of a nodule, mass, or area of consolidation.
- Cavitating pulmonary mass is also characterized by a thick wall (must be greater than 2 - 5 mm).
- The most common causes of cavitating pulmonary mass include malignancies, infections, inflammation processes, and congenital malformations.
- The table below summarizes the most common causes of cavitating pulmonary mass:
| Cavitating causes | Conditions | Description |
|---|---|---|
| Malignancy |
|
|
| Infection |
Abscess:
Empyema: | |
|
Non-infectious |
| |
| ||
| Congenital |
|
Imaging Evaluation
The evaluation of lung mass depends on the following 5 characteristics:[2][3]
- Calcification: Calcification patterns are commonly seen in granulomatous disease and hamartomas. They are normally a sign of benign lung mass. The characteristic benign calcification patterns of lung mass include:
- Size: Any area of pulmonary opacification that measures more than 30 mm (3 cm) has to be evaluated to determine the histology of the tissue.
- Location: Common locations of lung mass are pleural, endobronchial, and parenchymal.
- Margins: The different types of margins for lung mass include lobulated or scalloped margins and smooth margins. The lobulated or scalloped margins are associated with intermediate malignancy probability whereas smooth margins are associated with benign nature of lung mass.
- Attenuation: Lung mass may have different types of attenuation. Common types of attenuation are solid (malignancy rate of only 7%), calcified, partly solid (malignancy rate of 63%), and ground glass (malignancy rate of 18%).
References
- ↑ Albert RH, Russell JJ (2009). "Evaluation of the solitary pulmonary nodule". Am Fam Physician. 80 (8): 827–31. PMID 19835344.
- ↑ Kundel HL (1981). "Predictive value and threshold detectability of lung tumors". Radiology. 139 (1): 25–9. doi:10.1148/radiology.139.1.7208937. PMID 7208937.
- ↑ Hochhegger B, Marchiori E, Sedlaczek O, Irion K, Heussel CP, Ley S, Ley-Zaporozhan J, Soares Souza A, Kauczor HU (2011). "MRI in lung cancer: a pictorial essay". Br J Radiol. 84 (1003): 661–8. doi:10.1259/bjr/24661484. PMC 3473490. PMID 21697415.