Pulmonary nodule overview
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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
Solitary pulmonary nodule (SPN) is defined as a relatively well defined round or oval pulmonary parenchymal lesion equal or smaller than 30 mm in diameter. Solitary pulmonary nodule is usually surrounded by pulmonary parenchyma and/or visceral pleura and is not associated with lymphadenopathy, atelectasis, or pneumonia. In the majority of the cases, solitary pulmonary nodule can be encountered as a incidental finding.[1][2] The nodule most commonly represents a benign tumor, such as a granuloma or hamartoma, but in around 20% of cases it represents a malignant cancer.[2] Approximately 10 to 20% of patients with lung cancer are diagnosed this way.[2] Thus, the possibility of cancer needs to be excluded through further radiological studies and interventions, possibly including surgical resection. The prognosis depends on the underlying condition.
Rule out the possibility of cancer
Classification
According to the Fleischner society, solitary pulmonary nodules can be classified according to size, morphology, and/or distribution (multiple/single).
Causes
Infectious, inflammatory
Differentiating Solitary Pulmonary Nodule from Other Diseases
Solitary pulmonary nodule may be differentiated according to imaging (size, border characteristics, and attenuation), histological, and clinical features, from other diseases that demonstrate similar imaging findings. Common differential diagnosis of solitary pulmonary nodule, include: hamartoma, granulomas, rheumatic nodule, and single metastasis
Epidemiology and Demographics
Solitary pulmonary nodules are common. The prevalence of solitary pulmonary nodule ranges between 8-51%. The incidence rate of solitary pulmonary nodule is approximately 45 per 100 000 individuals in the United States. The incidence of solitary pulmonary nodule increases with age, tobacco use, and prior cancer; the median age at diagnosis is between. Males are more commonly affected with lung masses than females. The male to female ratio is approximately 2 to 1.
25% Low dose CT screening have a nodule detected, goes up 39% 3 consecutive scans. Incidental or on screening 12% of nodules result malignant
Screening
According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for solitary pulmonary nodule.[3][4]
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Imaging
spherical opacity
Other Diagnostic Studies
Treatment
Therapeutic Management
References
- ↑ Ost D, Fein AM, Feinsilver SH (2003). "Clinical practice. The solitary pulmonary nodule". N. Engl. J. Med. 348 (25): 2535–42. doi:10.1056/NEJMcp012290. PMID 12815140. Unknown parameter
|month=ignored (help) - ↑ 2.0 2.1 2.2 Alzahouri K, Velten M, Arveux P, Woronoff-Lemsi MC, Jolly D, Guillemin F (2008). "Management of SPN in France. Pathways for definitive diagnosis of solitary pulmonary nodule: a multicentre study in 18 French districts". BMC Cancer. 8: 93. doi:10.1186/1471-2407-8-93. PMC 2373300. PMID 18402653.
- ↑ Recommendations. US preventive services task force(2016) http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=solitary_pulmonary_nodule Accessed on March, 15th 2016
- ↑ McWilliams A, Tammemagi MC, Mayo JR, et. al. Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med. 2013 Sep 5;369(10):910-9. doi:10.1056/NEJMoa1214726.