Wednesday, September 18, 2013

Case review 1: Solitary Pulmonary Nodule in chest x-ray

 PA chest x-ray 
PA chest x-ray (enlarged image) shows a homogeneous well defined nodule


History

A 34 year old man works in Oil & gas industry came for routine medical check up. He denied any symptoms but smokes 1 packet a day.

X-ray findings

Chest x-ray was done & showed a 1.5cm nodule in the left mid zone peripherally (yellow arrow). The nodule has well defined margin and is homogenous in density.
No associated calcification, hilar lymphadenopathy or pleural effusion. 
No bony changes such as rib metastases. 

Impression: The findings are consistent with a solitary pulmonary nodule. 

*Important notes: Nodule is defined as a lesion smaller than 3 cm. Meanwhile, mass is a lesion larger than 3cm.


Differential diagnosis of Solitary pulmonary nodule includes:
-Granulomas
-hamartoma
-bronchial carcinoma


Further management

Depending on clinical presentation, the nodule most commonly represents a benign tumour such as a granuloma or hamartoma. 
However, around 20% of cases it represents a malignant cancer, especially in older adults and smokers.
Thus, further radiological studies such as CT chest & lung biopsy will be very helpful to exclude the possibility of cancer.




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