Lung mass resident survival guide: Difference between revisions
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==FIRE: Focused Initial Rapid Evaluation== | ==FIRE: Focused Initial Rapid Evaluation== | ||
A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients of lung mass. | A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients of lung mass. | ||
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{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | N01 |N01=Surgical excision/Chemo depending upon histopathology}} | {{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | N01 |N01=Surgical excision/Chemo depending upon histopathology}} | ||
{{Family tree/end}} | {{Family tree/end}} | ||
==Complete Diagnostic Approach== | |||
A complete diagnostic approach should be carried out after a focused initial rapid evaluation is conducted and following initiation of any urgent intervention. | |||
==References== | ==References== | ||
Revision as of 19:49, 6 March 2018
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief:
Overview
Lung mass (also known as "Pulmonary mass") is defined as any area of pulmonary opacification that measures more than 30 mm (3 cms) in the lung. Lung mass are abnormal growths found in the lung which can be either be benign or malignant. The most common cause of a pulmonary mass is lung cancer. Other causes of lung mass include granuloma, lipoma, tuberculosis, and aspergillosis.
Classification
Lung mass may be classified on the basis of histopathology into benign lung mass and malignant lung mass. In addition, lung mass can be sub-classified according to the location, imaging features, size, and distribution.
| Lung mass | |||||||||||||||||||||||||||||||||||
| Location | Histology | Imaging Features | |||||||||||||||||||||||||||||||||
| •Pleural •Endobronchial •Parenchymal | •Malignant mass •Benign mass | •Hyperdense pulmonary mass •Cavitating pulmonary mass | |||||||||||||||||||||||||||||||||
Causes
The common causes of lung mass include:[1][2][3][4][5]
- Lung cancer
- Hamartomas
- Hodgkin's lymphoma
- Pleural malignant mesothelioma
- Metastasis
- Fibroma
- Lymphoma
- Asbestos
- Lung abscess
- Lipomas
- Rheumatoid arthritis
- Silica
- Smoking
- Tuberculosis
FIRE: Focused Initial Rapid Evaluation
A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients of lung mass.
| Identify cardinal findings that increase the pretest probability of lung mass ❑ Dyspnea ❑ Chronic cough ❑ Hemoptysis ❑ Wheezing ❑ Chest pain ❑Cachexia ❑Fatigue ❑Loss of appetite ❑Dysphonia | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Advise chest x ray (CXR) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Lung opacity on Chest X ray (CXR) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Size >3 cms; classified as lung mass | Size <3 cms; classified as pulmonary nodule | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| High resolution chest CT scan | Check previous CXR | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Imaging features | Previous CXR normal; suggesting new growth | Previous CXR shows opacity but stable in size since then | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hyperdense pulmonary mass ❑Internal/eccentric calcification | Cavitating pulmonary mass ❑ Gas-filled area ❑ Thick/spiculated wall (must be greater than 2-5 mm) | Follow up every 2-3 yrs | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Other diagnostic studies ❑ Sputum cytology ❑ Endobronchial ultrasound ❑ Endoscopic ultrasound ❑ Bronchoscopy ❑ Mediastinoscopy | High resolution chest CT scan | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Highly suspicious for malignancy •Age >60yrs •Current smoker •Size >2cms | Suspicious for malignancy •Age 40-60yrs •Current smoker •Size 0.8-2cms | Benign features •Age <40yrs •Non smoker •Size <0.8cm | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| PET or biopsy | Serial CT scans | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| PET with biopsy | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Malignancy | No evidence of malignancy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Surgical excision/Chemo depending upon histopathology | No growth over time | Lesion grows over time | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Surgical excision/Chemo depending upon histopathology | Serial CT scans | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No further workup | PET with or biopsy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Surgical excision/Chemo depending upon histopathology | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Complete Diagnostic Approach
A complete diagnostic approach should be carried out after a focused initial rapid evaluation is conducted and following initiation of any urgent intervention.
References
- ↑ CDC (Dec 1986). "1986 Surgeon General's report: the health consequences of involuntary smoking". CDC. PMID 3097495. Retrieved 2007-08-10.
* National Research Council (1986). Environmental tobacco smoke: measuring exposures and assessing health effects. National Academy Press. ISBN 0-309-07456-8.
* Template:Cite paper
* California Environmental Protection Agency (1997). "Health effects of exposure to environmental tobacco smoke". Tobacco Control. 6 (4): 346–353. PMID 9583639. Retrieved 2007-08-10.
* CDC (Dec 2001). "State-specific prevalence of current cigarette smoking among adults, and policies and attitudes about secondhand smoke—United States, 2000". Morbidity and Mortality Weekly Report. CDC. 50 (49): 1101–1106. PMID 11794619. Retrieved 2007-08-10.
* Alberg, AJ (Jan 2003). "Epidemiology of lung cancer". Chest. American College of Chest Physicians. 123 (S1): 21S–49S. PMID 12527563. Retrieved 2007-08-10. Unknown parameter|coauthors=ignored (help) - ↑ Parent, ME (Jan 2007). "Exposure to diesel and gasoline engine emissions and the risk of lung cancer". American Journal of Epidemiology. 165 (1): 53–62. PMID 17062632. Unknown parameter
|coauthors=ignored (help) - ↑ Boffetta, P (Oct 1998). "Multicenter case-control study of exposure to environmental tobacco smoke and lung cancer in Europe". Journal of the National Cancer Institute. Oxford University Press. 90 (19): 1440–1450. PMID 9776409. Retrieved 2007-08-10. Unknown parameter
|coauthors=ignored (help) - ↑ "Report of the Scientific Committee on Tobacco and Health". Department of Health. Mar 1998. Retrieved 2007-07-09.
* Hackshaw, AK (Jun 1998). "Lung cancer and passive smoking". Statistical Methods in Medical Research. 7 (2): 119–136. PMID 9654638. - ↑ Template:Cite paper