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Lung Nodules

David Krasinski

Background

  • Definition: focal, distinct radiographic density completely surrounded by lung tissue <3cm (mass >3cm – see “Lung Mass” chapter)

  • Prevalence: 30% of all chest CTs. Most commonly are incidentalomas. >95% are benign. Larger and irregularly shaped nodules are more likely to be malignant.

Management of solitary lung nodule

  • History: hx of exposures (tobacco, asbestos, mining, biomass fuel), geographical epidemiology (histo/coccidio/TB), B-symptoms, personal and FxHx of malignancy

  • Assess pt risk for malignancy

  • High risk: >60yo, current smoker or heavy smoking history, history of cancer, FxHx lung cancer, irregular or spiculated, upper lobe, ≥2.3cm, double diameter or volume in past year
  • There are online risk calculators (Brock, Mayo, Herder) helpful for providers who are not experts in lung nodule risk stratification

  • Benign imaging features: central calcification, popcorn-like (hamartomas), laminated, stippled

  • Consider Pulmonary referral if high risk features, known malignancy or recent history of malignancy, organ transplant or other immunocompromising condition, age <35yo

- Fleischner guidelines for nodules <8mm