Lung Nodules¶
David Krasinski
Background¶
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Definition: focal, distinct radiographic density completely surrounded by lung tissue <3cm (mass >3cm – see “Lung Mass” chapter)
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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¶
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History: hx of exposures (tobacco, asbestos, mining, biomass fuel), geographical epidemiology (histo/coccidio/TB), B-symptoms, personal and FxHx of malignancy
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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
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There are online risk calculators (Brock, Mayo, Herder) helpful for providers who are not experts in lung nodule risk stratification
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Benign imaging features: central calcification, popcorn-like (hamartomas), laminated, stippled
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Consider Pulmonary referral if high risk features, known malignancy or recent history of malignancy, organ transplant or other immunocompromising condition, age <35yo