Pulmonary nodule chest x ray: Difference between revisions

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{{Solitary pulmonary nodule}}
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==Overview==
==Overview==
==Chest X Ray==
Several features help to distinguish benign conditions from possible lung cancer. The first parameter is the size of the lesion: the smaller, the less risk for malignant cancer.<ref name="Radiology2006"/> Benign causes tend to have a well defined border, whereas lobulated lesions or those with an irregular margin extending into the neighbouring tissue tend to be malignant.<ref name="Radiology2006"/>


If there is a central cavity, then a thin wall points to a benign cause whereas a thick wall is associated with malignancy (especially 4mm or less versus 16mm or more).<ref name="Radiology2006"/> In lung cancer, cavitation can represent central tumor [[necrosis]] (tissue death) or secondary abces formation. If the walls of an airway are visible (air bronchogram), [[bronchioloalveolar carcinoma]] is a possibility.
On conventional radiography, characteristic findings of solitary pulmonary nodule, include: well-defined, small, rounded capacities within the pulmonary interstitium, usually  8 mm in diameter, normally surrounded by normal aerated lung.
 
An SPN often contains calcifications. Certain patterns of calcification are reassuring, such as the popcorn-like appearance of hamartoma.<ref name="NEJM-cp"/> An SPN with a density below 15 Hounsfield units on [[computed tomography]] tends to be benign, whereas malignant tumors often measure more than 20 Hounsfield units. Fatty tissue inside hamartomas will have a strongly negative value on the Hounsfield scale.
 
The growth velocity of a lesion is also informative: very fast or very slow growing tumors are rarely malignant, in contrary to inflammatory or congenital conditions.<ref name="pmid10682770">{{cite journal |author=Erasmus JJ, Connolly JE, McAdams HP, Roggli VL |title=Solitary pulmonary nodules: Part I. Morphologic evaluation for differentiation of benign and malignant lesions |journal=Radiographics |volume=20 |issue=1 |pages=43–58 |year=2000 |pmid=10682770 |doi= |url=http://radiographics.rsnajnls.org/cgi/pmidlookup?view=long&pmid=10682770}}</ref> It is therefore important to retrieve previous imaging studies to see if a lesion was presented and how fast its volume is increasing. This is more difficult for nodules smaller than 1 centimeter. Moreover, the predictive value of stable lesion over a period of 2 years has been found to be rather low and unreliable.<ref name="pmid10682770"/>
 
[http://www.peir.net Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
 
 
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Image:Malignant solitary pulmonary nodule 1.jpg|Malignant solitary pulmonary nodule: The patient is a 67 year old woman with a solitary pulmonary nodule on a recent chest x-ray. A retrospective review of prior chest x-rays suggests that this is nodule is of recent origin. This lesion was felt to be too peripheral for reliable bronchial wash findings. Concern over potential sampling error associated with needle biopsy prompted a referral for PET imaging to rule out a malignant process.
Image:Malignant solitary pulmonary nodule 2.PET.jpg|After a 4 hour fast, the patient was injected with 10 mCi of 18-FDG IV and after allowing one hour for localization, transmission and emission PET data were acquired. A hypermetabolic focus can be seen in the left upper lobe corresponding to the chest x-ray abnormality. No other abnormalities are seen. The hypermetabolic nodule suggests a malignant process without metastasis. Lesions with only slight tracer uptake can be evaluated quantitatively for significance. A significant uptake value (SUV) can be calculated by dividing the mean activity in the suspicious area (mCi/ml) by the injected dose (mCi) per kilograms of body weight. Using a (SUV) of 2.5 or greater to define a malignancy, the sensitivity and specificity of 18-FDG-PET for detecting cancer in solitary pulmonary nodules greater than 1.2 cm approaches 90% with a nearly 100% specificity (1). False positives have included infectious etiologies, and sarcoid.
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Image:Pulmonary AVM as nodule 1.jpg|Chest x-ray: A 32 year old woman. 1. Two pulmonary arteriovenous malformations consistent with the nodules seen on the recent chest film. There is breathing artifact on several of the images and other tiny AVMs cannot be excluded. 2. Cardiomegaly with right atrial and left atrial enlargement and hepatic congestion.
Image:Pulmonary AVM as nodule 2.jpg|Thorax CT
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==Chest X Ray==


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*Conventional chest radiograph may be helpful in the diagnosis of pulmonary nodules.
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*The majority of pulmonary nodules require further evaluation with [[Computed tomography|CT scan]] and [[MRI]]
Image:Pulmonary AVM as nodule 3.jpg|Thorax CT
*On conventional radiography, characteristic findings of pulmonary nodule, include:<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>  
Image:Pulmonary AVM as nodule 4.jpg|Thorax CT
:*Soft-tissue density mass
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:*Round or oval in shape
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:*Smooth margin
:*Diameter of 8 mm and irregular margins
:*Surrounded by areas of ground glass change


==Gallery==


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Image:Pulmonary AVM as nodule 5.jpg|Thorax CT
Image:Malignant solitary pulmonary nodule 1.jpg|'''Malignant pulmonary nodule''':The patient is a 67 year old woman with a solitary pulmonary nodule on a recent chest x-ray. A retrospective review of prior chest x-rays suggests that this is nodule is of recent origin. This lesion was felt to be too peripheral for reliable bronchial wash findings [http://www.peir.net Images shown above are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
Image:Pulmonary AVM as nodule 6.jpg|Thorax CT
Pulmonary AVM as nodule 1.jpg|'''Arteriovenous malformations''': Two pulmonary arteriovenous malformations consistent with the nodules seen on the recent chest film. There is breathing artifact on several of the images and other tiny AVMs cannot be excluded.[http://www.peir.net Images shown above are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
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Image:Pulmonary AVM as nodule 7.jpg|Thorax CT
Image:Pulmonary AVM as nodule 8.jpg|Thorax CT
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==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WS}}


[[Category:Types of cancer]]
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Latest revision as of 21:36, 23 March 2016


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

On conventional radiography, characteristic findings of solitary pulmonary nodule, include: well-defined, small, rounded capacities within the pulmonary interstitium, usually 8 mm in diameter, normally surrounded by normal aerated lung.

Chest X Ray

  • Conventional chest radiograph may be helpful in the diagnosis of pulmonary nodules.
  • The majority of pulmonary nodules require further evaluation with CT scan and MRI
  • On conventional radiography, characteristic findings of pulmonary nodule, include:[1]
  • Soft-tissue density mass
  • Round or oval in shape
  • Smooth margin
  • Diameter of 8 mm and irregular margins
  • Surrounded by areas of ground glass change

Gallery


References

  1. 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.


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