eMedicine Specialties > Radiology > Chest

Hamartoma, Lung: Imaging

Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Coauthor(s): Sarah Al Ghanem, MBBS, Consulting Staff, Department of Medical Imaging, King Fahad National Guard Hospital, Riyadh, Saudi Arabia; Klaus L Irion, MD, PhD, Consulting Staff, The Cardiothoracic Centre Liverpool NHS Trust, The Royal Liverpool University Hospital, UK; Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute; Carolyn M Allen, MB, BCh, MRCP, FRCR, CCST, Consultant Radiologist, Department of Clinical Radiology, North Manchester General Hospital, UK
Contributor Information and Disclosures

Updated: Sep 22, 2008

Radiography

Findings

On chest radiographs, pulmonary hamartomas characteristically appear as well-defined, solitary pulmonary nodules; they may show varying patterns of calcification, including an irregular popcorn, stippled, or curvilinear pattern, or even a combination of all 3 patterns. Calcification that is detectable on plain radiography is reported to occur in 10-15% of patients. Popcorn calcification is virtually diagnostic.

Most lesions are smaller than 4 cm in diameter and well circumscribed; they are usually lobulated. The lesions show no lobar predominance, and cavitation is extremely rare. In unusual cases, bronchial obstruction occurs with a central tumor, causing obstructive pneumonitis, bronchiectasis, and progressive peripheral lung destruction.

Serial chest radiographs may demonstrate slow growth. Rapid growth has rarely been reported. This feature may make the differentiation of a hamartoma from a bronchogenic carcinoma difficult.

Degree of Confidence

When calcification or fat is detected in a well-circumscribed peripheral lung tumor, a diagnosis of hamartoma can confidently be made. However, the characteristic calcification is seen in only approximately 15% of patients, and detection of fat within a nodule is even rarer on plain radiographs.

False Positives/Negatives

When a central lucency occurs in a hamartoma because of the presence of adipose tissue, the lucency may be misinterpreted as air within a cavity, resulting in a significantly different differential diagnosis. When no characteristic calcification or fat is identified in a coin lesion or when multiple lesions are present, the differential diagnosis is extensive (see Differentials).

Computed Tomography

Findings

The fundamental appearances of hamartomas on CT scans are similar to those on chest radiographs. However, thin sections also allow for more detailed evaluation of the internal architecture and morphology of lesions.19,20,21 In particular, calcium and fat are better visualized with CT scanning than with radiography.22,23 The Hounsfield values for fat lie within the range of -50 to -120 HU. Fat is identified in 34-50% of lesions, and calcification, in 15-30%.

On high-resolution CT (HRCT) scans, fat attenuation is detectable in 34% of tumors, and fat and calcium, in 19%. The finding of fat and calcification together is a specific combination for hamartomas, particularly in tumors below 2.5 cm in diameter. The frequency of calcification increases with increasing tumor size; calcification is found in only 10% of lesions smaller than 2 cm, but this rate reaches 75% for lesions larger than 5 cm.

CT scanning may also have a role in the diagnosis of the Carney triad.

Degree of Confidence

CT scanning is more sensitive than chest radiography in the detection of fat and calcification. Hamartoma may be confidently diagnosed when a sharply marginated, smooth lesion containing calcification and fat is identified on a CT scan.

False Positives/Negatives

In one third of hamartomas, no calcium or fat is demonstrable on CT scans. The differential diagnosis is extensive in these cases. Central endobronchial tumors may have features that are indistinguishable from those of a bronchial carcinoid.

Magnetic Resonance Imaging

Findings

MRI is not used in the detection or diagnosis of pulmonary hamartomas. However, MRI is the modality of choice for screening and follow-up of suspected cases of the Carney triad if clinical and biochemical evidence suggests that a paraganglioma is present.

Degree of Confidence

MRI is said to be as sensitive as iodine-131-meta-iodobenzylguanidine (MIBG) scintigraphy in the diagnosis of paraganglioma, but it may not be useful in differentiating paragangliomas from other neurogenic tumors in the Carney triad.24

False Positives/Negatives

MRI may not be helpful in differentiating between paragangliomas and other neurogenic tumors.

Ultrasonography

Findings

Ultrasonography is not used in the detection or diagnosis of pulmonary hamartomas. However, transthoracic ultrasonographic guidance may be employed in image-guided percutaneous biopsy of lesions in close contact with the chest wall. Ultrasonography may also be useful in the diagnosis of nonthoracic manifestations of a Carney triad.

Nuclear Imaging

Findings

A paraganglioma that is associated with the Carney triad may be identified with iodine-123 or iodine-131 MIBG scanning. Radionuclide studies have no role in the diagnosis of a lung hamartoma.

Degree of Confidence

MIBG radionuclide scanning is a reliable and noninvasive technique in the diagnosis of paragangliomas.

False Positives/Negatives

MIBG uptake may occur in other neuroendocrine tumors.

Angiography

Findings

Angiography has no role in the diagnosis of a lung hamartoma.

More on Hamartoma, Lung

Overview: Hamartoma, Lung
Imaging: Hamartoma, Lung
Follow-up: Hamartoma, Lung
Multimedia: Hamartoma, Lung
References
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References

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Further Reading

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Keywords

lung hamartoma, hamartochondroma, chondromatous hamartoma, Carney's triad, Carney triad, Carney's syndrome, Carney syndrome, pulmonary chondroma, solitary pulmonary nodule, benign lung tumor

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Contributor Information and Disclosures

Author

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP is a member of the following medical societies: American Institute of Ultrasound in Medicine, Radiological Society of North America, Royal College of Physicians, Royal College of Physicians and Surgeons of the United States, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Coauthor(s)

Sarah Al Ghanem, MBBS, Consulting Staff, Department of Medical Imaging, King Fahad National Guard Hospital, Riyadh, Saudi Arabia
Disclosure: Nothing to disclose.

Klaus L Irion, MD, PhD, Consulting Staff, The Cardiothoracic Centre Liverpool NHS Trust, The Royal Liverpool University Hospital, UK
Klaus L Irion, MD, PhD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Sumaira MacDonald, MBChB, PhD, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Carolyn M Allen, MB, BCh, MRCP, FRCR, CCST, Consultant Radiologist, Department of Clinical Radiology, North Manchester General Hospital, UK
Carolyn M Allen, MB, BCh, MRCP, FRCR, CCST is a member of the following medical societies: Society of Thoracic Radiology
Disclosure: Nothing to disclose.

Medical Editor

Kitt Shaffer, MD, PhD, Director of Undergraduate Medical Education, Associate Professor, Department of Radiology, Cambridge Health Alliance
Kitt Shaffer, MD, PhD is a member of the following medical societies: American Roentgen Ray Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

W Richard Webb, MD, Chief of Thoracic Imaging, Professor, Department of Radiology, University of California at San Francisco
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Barry H Gross, MD, Professor, Department of Radiology, University of Michigan Medical School; Professor, University of Michigan Cancer Center
Barry H Gross, MD is a member of the following medical societies: American College of Chest Physicians, American College of Radiology, American Roentgen Ray Society, Association of University Radiologists, Michigan State Medical Society, Physicians for Social Responsibility, Radiological Society of North America, and Society of Thoracic Radiology
Disclosure: Nothing to disclose.

 
 
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