Radiology Notes

My notes during radiology residency, fellowship, and beyond…

Archive for the ‘nodule’ Category

Centrilobular Lung Nodules

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  • bronchiolitis
  • endobronchial spread of TB, MAC
  • bronchopenumonia
  • hypersensitivity pneumonitis
  • endobronchial spread of tumor
  • pneumoconiosis
  • organizing pneumonia (BOOP)
  • histiocytosis
  • edema or vasculitis
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Written by lmwong

April 25, 2010 at 5:17 pm

Random Lung Nodules

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  • miliary TB
  • miliary fungal infections
  • hematogenous mets
  • sarcoidosis

Written by lmwong

April 25, 2010 at 5:09 pm

Perilymphatic Lung Nodules

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  • sarcoid
  • lymphangitic spread of tumor
  • silicosis and CWP
  • amyloid
  • LIP

Written by lmwong

April 25, 2010 at 5:00 pm

AIDS Chest Differential

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Focal Lung Disease

  • Bacterial pneumonia
  • PCP
  • Mycobacterial/fungal infection
  • Non-Hodgkin lymphoma

Diffuse lung disease

  • PCP
  • PCP + infection
  • Mycobacterium tuberculosis
  • Fungal infection
  • NSIP
  • Lymphocytic interstitial pneumonia
  • Kaposi sarcoma

Nodules

  • Non-Hodgkin lymphoma
  • Kaposi sarcoma
  • Septic emboli
  • Mycobacterial/fungal infection

Adenopathy

  • Mycobacterial/fungal infection
  • Kaposi Sarcoma
  • Non-Hadgkin lymphoma
  • PCP

Pleural Effusion

  • Kaposi Sarcoma
  • Mycobacterial/fungal infection
  • Non-Hadgkin lymphoma
  • Pyogenic empyema
  • PCP

Written by lmwong

January 19, 2010 at 11:58 pm

Wegener’s Granulomatosis

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  • necrotizing vasculitis
  • upper respiratory tracts, lungs, renal glomeruli
  • lungs
    • multiple pulmonary nodules; 50% cavitate, angiocentric
    • diffuse alveolar consolidation = hemorrhage
  • +cANCA
  • Rx: cyclophosphamide and steroids

Written by lmwong

January 19, 2010 at 7:54 pm

Solitary Pulmonary Nodule Workup

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  • Nipple? Use nipple markers…it’s cheap and fast.
  • 3cm = mass
  • 95% fall into 1 of 3: malignant neoplasm, infectious granulomas, benign hamartoma
  • Always: Look at AP/LA views; Look for old studies
  • What to think about:
  1. Clinical ( 35yo)
  2. Growth pattern (doubling time)
  3. Size (not reliable)
  4. Margins
  5. density

Most likely B9 if:

  • Calcium (extremely rare eccentric scar carcinomas and carcinoid tumors) or fat present (hamartoma)
  • well circumscribed

Volume Doubling time (increased diameter by 25%):

  • 1-24 months = bronchogenic carcinoma
  • >24 months = granuloma, hamartoma, bronchial carcinoid, salivary gland adenoid cystic carcinoma, thyroid carcinoma met, round atelectasis, adenocarcinoma, carcinoid tumors

Margins
Smooth, well circumscribed

  • Most likely benign = granuloma, hamartoma
  • Rare malignant causes = carcinoid tumor, adenocarcinoma, solitary met

– Other (notched, lobulated, spiculated)

  • Strongly suggestive of malignancy, but not diagnositic
  • B9 causes = lipod pneumonia, organizing pneumonia, TB, progressive fibrosis from silicosis
  • Differentiate round atelectasis (on CT):
    • Comet tail of bronchi and vessels swirling around density
    • Crow’s feet branching from consolidation to lung parenchyma
    • Associated with pleural effusion or pleural disease (ie asbestos)
    • Lung bases predominate

Density ( most important factor)

  • Calcification pattern:
    • B9 = central, complete, concentric/laminated, peripheral, or popcorn
    • Bronchogenic Carcinoma = eccentric internal calcification (engulfment)
  • Fat = harmartoma

Contrast Enhancement

  • Virtually all malignant lesions enhance 15HU
  • Lack of significant enhancement = B9

PET

  • FDG-PET has high sensitivity and specificity for lesions >10mm (97% and 78%), for being malignant

Fleischner Society Guidelines: Radiology 2005 Nov; 237:395-400.

Low risk patients

  • < or = 4 mm: No follow-up needed.
  • >4 – 6: Follow-up at 12 months. If no change, no further imaging needed.
  • >6 – 8: Initial follow-up CT at 6 -12 months and then at 18 – 24 months if no change.
  • >8: Follow-up CTs at around 3, 9, and 24 months. Dynamic contrast enhanced CT, PET, and/or biopsy.

High risk patients

  • < or = 4 mm: Follow-up at 12 months. If no change, no further imaging needed.
  • >4-6: Initial follow-up CT at 6 -12 months and then at 18 – 24 months if no change.
  • >6-8: Initial follow-up CT at 3 – 6 months and then at 9 -12 and 24 months if no change.
  • >8: Follow-up CTs at around 3, 9, and 24 months. Dynamic contrast enhanced CT, PET, and/or biopsy.

Management Algorithm

Differential Diagnosis

Written by lmwong

April 8, 2008 at 2:51 am

Posted in chest, nodule, pulmonary

Multiple Pulmonary Nodules

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  • Mets
  • **Infection (Histoplasmosis) **
  • Lymphoma (non-Hodgkins, + gallium scan)
  • Bronchogenic Carcinoma
  • Kapsoi’s sarcoma (+HIV)
  • Granulomatous Disease
  • Sarcoidosis
  • Wegener’s Granulomatosis
  • RA
  • Amyloid
  • Septic emboli

lung

Written by lmwong

April 5, 2008 at 7:05 pm