pulmonary nodule
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Classification
- a solitary pulmonary nodule is a single lesion up to 3 cm in diameter, surrounded by normal lung tissue, & not associated with lymphadenopathy
- a lesion larger than 3 cm is considered a lung mass*
* pulmonary nodules > 3 cm are presumed malignant until proven otherwise[1]
Etiology
- see solitary pulmonary nodule
- solitary or multiple nodules may represent metastases to the lung
- Mycobacterium: tuberculosis, Mycobacterium avium complex
- Pneumocystis pneumonia
- histoplasmosis
- hypersensitivity pneumonitis
Pathology
- a lung cancer is often associated with smaller benign nodules
- 35% of pulmonary nodules 8-20 mm surgically excised are benign[4]
Diagnostic procedures
- fiberoptic bronchoscopy for centrally located lung mass with endobronchial component
- see lung carcinoma for suspected lung cancer
- needle aspiration of suspicious peripheral lymph node[1]
Radiology
- computed tomography (non-contrast)[1]
- PET scan unlikely to detect lesions < 1 cm in size[1]
- specificity of fludeoxyglucose 18F-PET lower in areas of endemic infectious disease[3]
Management
- also see solitary pulmonary nodule
- 1 predominant nodule > 1 cm in diameter & >= smaller nodules
- endobronchial ultrasound-guided transbronchial needle biopsy if mediastinal lymphadenopathy in addition to pulmonary nodule[1]
- biopsy a lung mass
- incidentalomas < 1 cm in size (regardless of number)
More general terms
More specific terms
Additional terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018, 2022.
- ↑ 2.0 2.1 MacMahon H, Austin JH, Gamsu G, Herold CJ et al Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. Radiology. 2005 Nov;237(2):395-400. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16244247
- ↑ 3.0 3.1 Deppen SA et al Accuracy of FDG-PET to Diagnose Lung Cancer in Areas With Infectious Lung DiseaseA Meta-analysis. JAMA. 2014;312(12):1227-1236 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25247519 JAMA. 2014;312(12):1227-1236
- ↑ 4.0 4.1 Tanner NT et al. Management of pulmonary nodules by community pulmonologists: A multicenter observational study. Chest 2015 Dec; 148:1405. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26087071 <Internet> http://journal.publications.chestnet.org/article.aspx?articleid=2337001
Wiener RS et al. Pulmonologists' reported use of guidelines and shared decision-making in evaluation of pulmonary nodules: A qualitative study. Chest 2015 Dec; 148:1415 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25789979 <Internet> http://journal.publications.chestnet.org/article.aspx?articleid=2209998 - ↑ Gould MK, Donington J, Lynch WR et al Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e93S-e120S. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23649456 Free PMC Article
- ↑ NEJM JWatch Question of the Week. March 27, 2018 https://knowledgeplus.nejm.org/question-of-week/562/