Lung mass 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
Lung mass (also known as "Pulmonary mass") is generally defined as any area of pulmonary opacification that measures more than 30 mm in the lung. Abnormal growths found in the lung can be benign or malignant. Lung masses may be classified according to location, imaging features, size, and distribution. The prevalence of lung masses is approximately 58 per 100,000 individuals. Lung masses have a wide age distribution. However, the majority of these lesions are more often diagnosed in adults. The most common symptom of a lung mass is cough, which will gradually persist over time. Other symptoms may include: dyspnea, hemoptysis, chronic coughing, wheezing, and chest pain. In some cases, lung masses may be asymptomatic.
Classification
Lung masses may be classified according to location, imaging features, and size. In addition, lung masses may be sub-classified according if they are single or multiple.
Causes
Lung masses may be idiopathic or caused by precursor lesions. Precursor lesions for some lung masses, may include: infections, metaplasia, hamartomatous formation, or displasia.
Differential Diagnosis
Lung masses may be differentiated according to clinical features, laboratory findings, imaging features, histological features, and genetic studies, from other diseases that cause cough, chest pain, or wheezing. Common differential diagnosis includes: lung cancer, tuberculosis, pulmonary abscess, granulomas, loculated pleural effusion, and metastases.
Epidemiology and Demographics
Bone and cartilage tumors are uncommon, they represent 0.2% of all neoplasms in general population. The prevalence of bone and cartilage tumors is approximately 0.9 per 100,000 individuals. Bone and cartilage tumors have a bimodal age distribution. These tumors are more frequent in children and adolescents, and older adults. The average age at diagnosis is between 10-25 years old and 60-75 years old. Males are more commonly affected than females, with a 1.5:1 ratio.[1] Bone and cartilage tumors are slightly more common among individuals of Caucasian race.[2]
Screening
According to the U.S. Preventive Services Task Force (USPSTF) there is sufficient evidence to recommend routine screening for lung masses. Screening for suspected lung cancer by low-dose computed tomography is recommended every year among smokers who are between 55 to 80 years old and who have history of smoke 30 pack-years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).[3][4][5]
Diagnosis
Evaluation of Lung Mass
The evaluation of lung mass will depend on detailed medical history, age, morphology of the lesion, size, distribution.
Staging
History and Symptoms
Lung masses are generally asymptomatic. The majority of patients may develop non-specific symptoms, such as: dyspnea, hemoptysis, chronic coughing, wheezing, and chest pain. Obtaining the detailed history is an important aspect of making a diagnosis of lung masses, specific areas of focus when obtaining the history, are personal history of cancer, family history of lung cancer, previous infections, recent hospitalization, .[6]
Physical Examination
Physical examination findings of lung masses will depend on the location of the tumor. Common physical examination findings, include: reduced chest expansion, crackling or bubbling noises, decreased/absent breath sounds, and whispered pectoriloquy.[7]
Laboratory Studies
Laboratory findings consistent with the diagnosis of lung masses, may include: elevated LDH, elevated alkaline phosphatase (related with prognosis), and elevated aspartate aminotransferase (AST).[8]
Imaging
Conventional radiography is initial method of choice for the diagnosis of lung masses. The evaluation lung masses will depend on several characteristics, such as: size, pattern, presence of calcifications, attenuation, location, and previous imaging studies. CT is the gold standard for the complete evaluation of lung masses.
Biopsy
Lung biopsy findings associated with lung masses will depend on tumor histology, common findings include:
Other Diagnostic Studies
References
- ↑ Franchi A (2012). "Epidemiology and classification of bone tumors". Clin Cases Miner Bone Metab. 9 (2): 92–5. PMC 3476517. PMID 23087718.
- ↑ Tubiana-Hulin M (1991). "Incidence, prevalence and distribution of bone metastases". Bone. 12 Suppl 1: S9–10. PMID 1954049.
- ↑ Lung Cancer: Screening http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening. Accessed on February 3, 2016
- ↑ Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.
- ↑ National Lung Screening Trial. Wikipedia. https://en.wikipedia.org/wiki/National_Lung_Screening_Trial Accessed on February 4,2016
- ↑ Hakim DN, Pelly T, Kulendran M, Caris JA (2015). "Benign tumours of the bone: A review". J Bone Oncol. 4 (2): 37–41. doi:10.1016/j.jbo.2015.02.001. PMC 4620948. PMID 26579486.
- ↑ Hyde L, Hyde CI (1974). "Clinical manifestations of lung cancer". Chest. 65 (3): 299–306. PMID 4813837.
- ↑ Tsukushi S, Katagiri H, Kataoka T, Nishida Y, Ishiguro N (2006). "Serum tumor markers in skeletal metastasis". Jpn. J. Clin. Oncol. 36 (7): 439–44. doi:10.1093/jjco/hyl046. PMID 16815865.