eMedicine Specialties > Pulmonology > Lung Tumors
Solitary Pulmonary Nodule: Multimedia
Updated: Sep 11, 2009
Multimedia
 | Media file 1: Right upper lobe nodule shows peripheral calcification and high Hounsfield unit enhancement, suggesting that the lesion is a calcified benign pulmonary nodule. |
 | Media file 2: A 1.5-cm coin lesion in the left upper lobe in a patient with prior colonic carcinoma. Transthoracic needle biopsy findings confirmed this to be a metastatic deposit. |
 | Media file 3: Mediastinal windows of the patient in Media File 2. |
 | Media file 4: Right lower lobe nodule demonstrating central calcification. The most likely diagnosis is histoplasmosis. |
 | Media file 5: Close-up view of a right lower lobe nodule demonstrating central calcification. The most likely diagnosis is histoplasmosis. |
 | Media file 6: Left upper lobe cavitating solitary nodule eventually identified as active pulmonary tuberculosis from percutaneous needle biopsy findings. |
 | Media file 7: A left upper lobe nodule with central lucency and poorly circumscribed margins was diagnosed as actinomycosis based on needle biopsy findings. |
 | Media file 8: CT scan of the patient presented in Media File 7. After needle biopsy, the presence of classic sulfur granules confirmed actinomycosis. |
 | Media file 9: A right lower lobe solitary pulmonary nodule later identified to be a hamartoma. |
 | Media file 10: Wedge-shaped peripheral (pleural based) density observed secondary to pulmonary infarction (pulmonary embolism). This is termed the Westermark sign. |
 | Media file 11: Left upper lobe 1.5-cm nodule shows negative CT scan numbers, suggesting fat in the lesion consistent with hamartoma. |
 | Media file 12: A left upper lobe solitary pulmonary nodule. The differential diagnosis is large, but CT scan findings help narrow the differentials and establish the diagnosis. |
 | Media file 13: Cavitating right lower lobe nodule later confirmed to be primary pulmonary lymphoma. Calcium deposits may also be present in the lesion. |
 | Media file 14: This left lower lobe carcinoid tumor was quite bloody after a percutaneous needle biopsy was performed. |
 | Media file 15: A lateral radiograph of the case in Media File 14. |
 | Media file 16: CT scan of the patient in Media File 14 shows a well-circumscribed lesion. |
 | Media file 17: A "popcorn" calcification in the left lung nodule indicates a benign lesion or hamartoma. No further tests or observations are needed for this patient. |
 | Media file 18: A 1.5-cm right upper lobe nodule on CT scan was determined to be a benign fibrous lesion on needle biopsy. A follow-up at 2 years showed no change in the size of this lesion. |
 | Media file 19: The parenchymal lesion in this CT scan demonstrates low attenuation within the lesion, indicating the presence of fat. Fat density is only observed in hamartoma and lipoid pneumonia. The likely diagnosis is hamartoma. |
 | Media file 20: This patient has a low risk for the right upper lobe nodule to be malignant; therefore, continued observation with repeat chest radiographs to establish a growth pattern is the best treatment option. |
More on Solitary Pulmonary Nodule |
| Overview: Solitary Pulmonary Nodule |
| Differential Diagnoses & Workup: Solitary Pulmonary Nodule |
| Treatment & Medication: Solitary Pulmonary Nodule |
| Follow-up: Solitary Pulmonary Nodule |
 Multimedia: Solitary Pulmonary Nodule |
| References |
| « Previous Page |
References
Lillington GA. Management of solitary pulmonary nodules. Dis Mon. May 1991;37(5):271-318. [Medline].
Wahidi MM, Govert JA, Goudar RK, Gould MK, McCrory DC. Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. Sep 2007;132(3 Suppl):94S-107S. [Medline].
[Guideline] Gould MK, Fletcher J, Iannettoni MD, et al. Evaluation of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. Sep 2007;132(3 Suppl):108S-130S. [Medline]. [Full Text].
Cardinale L, Ardissone F, Novello S, et al. The pulmonary nodule: clinical and radiological characteristics affecting a diagnosis of malignancy. Radiol Med. May 29 2009;[Medline].
Swensen SJ, Viggiano RW, Midthun DE, et al. Lung nodule enhancement at CT: multicenter study. Radiology. Jan 2000;214(1):73-80. [Medline]. [Full Text].
Midthun DE, Swensen SJ, Jett JR, Hartman TE. Evaluation of nodules detected by screening for lung cancer with low dose spiral computed tomography. Lung Cancer. Aug 2003;41 (suppl 2):S40.
Ost D, Fein AM, Feinsilver SH. Clinical practice. The solitary pulmonary nodule. N Engl J Med. Jun 19 2003;348(25):2535-42. [Medline]. [Full Text].
Behzadi A, Ung Y, Lowe V, Deschamps C. The role of positron emission tomography in the management of non-small cell lung cancer. Can J Surg. Jun 2009;52(3):235-42. [Medline].
Gould MK, Maclean CC, Kuschner WG, Rydzak CE, Owens DK. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. JAMA. Feb 21 2001;285(7):914-24. [Medline].
Yi CA, Lee KS, Kim BT, Choi JY, Kwon OJ, Kim H. Tissue characterization of solitary pulmonary nodule: comparative study between helical dynamic CT and integrated PET/CT. J Nucl Med. Mar 2006;47(3):443-50. [Medline].
Naalsund A, Maublant J. The solitary pulmonary nodule--is it malignant or benign? Diagnostic performance of Tc-depreotide SPECT. Respiration. 2006;73(5):634-41. [Medline].
Herth FJ, Eberhardt R, Becker HD, Ernst A. Endobronchial ultrasound-guided transbronchial lung biopsy in fluoroscopically invisible solitary pulmonary nodules: a prospective trial. Chest. Jan 2006;129(1):147-50. [Medline]. [Full Text].
Herth FJ, Ernst A, Becker HD. Endobronchial ultrasound-guided transbronchial lung biopsy in solitary pulmonary nodules and peripheral lesions. Eur Respir J. Oct 2002;20(4):972-4. [Medline]. [Full Text].
Lacasse Y, Wong E, Guyatt GH, Cook DJ. Transthoracic needle aspiration biopsy for the diagnosis of localised pulmonary lesions: a meta-analysis. Thorax. Oct 1999;54(10):884-93. [Medline].
Tan BB, Flaherty KR, Kazerooni EA, Iannettoni MD. The solitary pulmonary nodule. Chest. Jan 2003;123(1 Suppl):89S-96S. [Medline]. [Full Text].
[Guideline] MacMahon H, Austin JH, Gamsu G, et al. Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. Radiology. Nov 2005;237(2):395-400. [Medline]. [Full Text].
Gurney JW. Determining the likelihood of malignancy in solitary pulmonary nodules with Bayesian analysis. Part I. Theory. Radiology. Feb 1993;186(2):405-13. [Medline]. [Full Text].
Watanabe A, Koyanagi T, Obama T, et al. Assessment of node dissection for clinical stage I primary lung cancer by VATS. Eur J Cardiothorac Surg. May 2005;27(5):745-52. [Medline]. [Full Text].
Shennib H. Intraoperative localization techniques for pulmonary nodules. Ann Thorac Surg. Sep 1993;56(3):745-8. [Medline].
Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. Sep 1995;60(3):615-22; discussion 622-3. [Medline].
Cummings SR, Lillington GA, Richard RJ. Estimating the probability of malignancy in solitary pulmonary nodules. A Bayesian approach. Am Rev Respir Dis. Sep 1986;134(3):449-52. [Medline].
Chhajed PN, Bernasconi M, Gambazzi F. Combining bronchoscopy and positron emission tomography for the diagnosis of the small pulmonary nodule < or = 3 cm. Chest. Nov 2005;128(5):3558-64.
Chung T. Fine needle aspiration of the solitary pulmonary nodule. Semin Thorac Cardiovasc Surg. Jul 2002;14(3):275-80. [Medline].
Decamp MM Jr. The solitary pulmonary nodule: aggressive excisional strategy. Semin Thorac Cardiovasc Surg. Jul 2002;14(3):292-6. [Medline].
Erasmus JJ, Connolly JE, McAdams HP, Roggli VL. Solitary pulmonary nodules: Part I. Morphologic evaluation for differentiation of benign and malignant lesions. Radiographics. Jan-Feb 2000;20(1):43-58. [Medline].
Erasmus JJ, McAdams HP, Connolly JE. Solitary pulmonary nodules: Part II. Evaluation of the indeterminate nodule. Radiographics. Jan-Feb 2000;20(1):59-66. [Medline].
Ginsberg RJ. The solitary pulmonary nodule: can we afford to watch and wait?. J Thorac Cardiovasc Surg. Jan 2003;125(1):25-6. [Medline].
Goldsmith SJ, Kostakoglu L. Role of nuclear medicine in the evaluation of the solitary pulmonary nodule. Semin Ultrasound CT MR. Apr 2000;21(2):129-38. [Medline].
Gould MK, Lillington GA. Strategy and cost in investigating solitary pulmonary nodules. Thorax. Aug 1998;53 Suppl 2:S32-7. [Medline].
Hartman TE. Radiologic evaluation of the solitary pulmonary nodule. Radiol Clin North Am. May 2005;43(3):459-65, vii. [Medline].
Herder GJ, van Tinteren H, Golding RP. Clinical prediction model to characterize pulmonary nodules: validation and added value of 18F-fluorodeoxyglucose positron emission tomography. Chest. Oct 2005;128(4):2490-6.
Jain P, Kathawalla SA, Arroliga AC. Managing solitary pulmonary nodules. Cleve Clin J Med. Jun 1998;65(6):315-26. [Medline].
Laurent F, Remy J. [Management strategy of pulmonary nodules]. J Radiol. Dec 2002;83(12 Pt 1):1815-21. [Medline].
Lillington GA. Management of solitary pulmonary nodules. How to decide when resection is required. Postgrad Med. Mar 1997;101(3):145-50. [Medline].
Lillington GA. Solitary pulmonary nodules: new wine in old bottles. Curr Opin Pulm Med. Jul 2001;7(4):242-6. [Medline].
Lillington GA, Caskey CI. Evaluation and management of solitary and multiple pulmonary nodules. Clin Chest Med. Mar 1993;14(1):111-9. [Medline].
Moses DA, Ko JP. Multidetector CT of the solitary pulmonary nodule. Semin Roentgenol. Apr 2005;40(2):109-25. [Medline].
Ost D, Fein A. Evaluation and management of the solitary pulmonary nodule. Am J Respir Crit Care Med. Sep 2000;162(3 Pt 1):782-7. [Medline].
Pepe G, Rossetti C, Sironi S, Landoni C, Gianolli L, Pastorino U. Patients with known or suspected lung cancer: evaluation of clinical management changes due to 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) study. Nucl Med Commun. Sep 2005;26(9):831-7. [Medline].
Plachcinska A, Mikolajczak R, Kozak J, Rzeszutek K, Kusmierek J. A visual and semi-quantitative assessment of (99m)Tc-EDDA/HYNIC-TOC scintigraphy in differentiation of solitary pulmonary nodules. Nucl Med Rev Cent East Eur. 2004;7(2):143-50. [Medline].
Pogodina VV. Elizaveta Nilolaevna Levkovich-75th birthday. Acta Virol. Nov 1975;19(6):509. [Medline].
Schaefer JF, Schneider V, Vollmar J, Wehrmann M, Aebert H, Friedel G. Solitary pulmonary nodules: association between signal characteristics in dynamic contrast enhanced MRI and tumor angiogenesis. Lung Cancer. Jul 2006;53(1):39-49. [Medline].
Schiavon F, Berletti R, Soardi GA. Multidisciplinary management of the solitary pulmonary nodule (SPN): our opinion. Radiol Med (Torino). Sep 2005;110(3):149-55.
Shaham D, Guralnik L. The solitary pulmonary nodule: radiologic considerations. Semin Ultrasound CT MR. Apr 2000;21(2):97-115. [Medline].
Siegelman SS, Zerhouni EA, Leo FP, Khouri NF, Stitik FP. CT of the solitary pulmonary nodule. AJR Am J Roentgenol. Jul 1980;135(1):1-13. [Medline].
Swensen SJ, Silverstein MD, Ilstrup DM, Schleck CD, Edell ES. The probability of malignancy in solitary pulmonary nodules. Application to small radiologically indeterminate nodules. Arch Intern Med. Apr 28 1997;157(8):849-55. [Medline].
Tan BB, Flaherty KR, Kazerooni EA, Iannettoni MD. The solitary pulmonary nodule. Chest. Jan 2003;123(1 Suppl):89S-96S. [Medline].
Tang AW, Moss HA, Robertson RJ. The solitary pulmonary nodule. Eur J Radiol. Jan 2003;45(1):69-77. [Medline].
Further Reading
Keywords
solitary pulmonary nodule, SPN, early lung cancer, histoplasmosis, coccidioidomycosis, blastomycosis, pulmonary mycosis, tuberculosis, TB, bronchogenic carcinoma, nocardiosis, asbestos exposure, radon exposure, nickel exposure, chromium exposure, vinyl chloride exposure, polycyclic hydrocarbon exposure, chemical exposure, industrial exposure, bronchogenic cancer, bronchogenic malignancy, pulmonary mycosis, mycosis, lung nodule, malignant nodule, lung lesion, lung malignancy, neoplasm, primary neoplasm, lung neoplasm, granuloma, infectious granuloma, lung granuloma, benign lung lesion, hamartoma, lymphoma, carcinoid, fibroma, neurofibroma, blastoma, sarcoma, lung abscess, round pneumonia, hydatid cyst, rheumatoid arthritis, RA, Wegener granulomatosis, sarcoidosis, lipoid pneumonia, arteriovenous malformation, AVM, lung cyst, pulmonary infarct, round atelectasis, mucoid impaction, mucus impaction, progressive massive fibrosis
