I Found a Lung Nodule on CT – What Is the Chance It Could Be Cancer?

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I found a lung nodule on CT – what is the chance it could be cancer? Sjirk J. Westra, M.D. Division of Pediatric Radiology Massachusetts General Hospital, Boston 10 y/o F, asymptomatic, PPD+ Case courtesy: Pallavi Sagar MD SAM 10 y/o F, asymptomatic, PPD+ Diagnosis? A. Bronchogenic carcinoma B. Bronchial carcinoid tumor C. BAC in CPAM D. PEComa E. Tuberculosis 13 y/o F, R chest pain SAM A. Bronchogenic 13 y/o F, carcinoma recurrent B. Osteosarcoma pneumonia metastasis Diagnosis? C. Bronchioalveolar carcinoma D. Bronchial carcinoid tumor E. Hamartoma Pediatric lung mass • Primary neoplasm 1 • Secondary (metastasis) 5 • Non-neoplastic 60 Cohen Pediatr Pulmonol 1992 Pediatric lung mass: Benign • Developmental: hamartoma • Inflammation/infection: –granuloma –inflammatory myofibroblastic lesion –pneumonia, atelectasis • Intrapulmonary lymph node • Scar Incidental nodules in Rio de Janeiro, Brasil Tronco Alves AJR 2015 • 99 children scanned for pectus: 225 nodules (75% of patients) • 2-8 mm, mean 2.8 mm • 10.7% calcified • Endemic for granulomatous disease Geography of fungal disease Intrapulmonary lymph node • Tends to be subcarinal • Within 15 mm of a pleural surface (incl. fissure) –Connected via pleural tag • Uniformly solid (> 0 HU) • Oval/polygonal shape Pediatric lung cancer • Pleuropulmonary blastoma: < 6 yr –Large solid, small cystic • Primary (bronchogenic ca): rare –Squamous cell ca: ~ papillomatosis • ~ Airways (carcinoid, …): symptomatic Embryonal RMS 6 mo M, treated for “round pneumonia”, did not resolve in 2 wk Pediatric lung cancer (cont.d) • Leiomyoma/-sarcoma ~ HIV, Tx, immune deficiency (EBV) • Bronchioalveolar carcinoma (BAC, adenocarcinoma) ~ Tx for extrathoracic malignancy ~ Chronic infections ~ CPAM – Ground glass nodule The incidentally-detected lung nodule • Fleischner guidelines do not apply –Solid nodule: intrapulmonary lymph node, granuloma, etc. , not cancer (?) –Ground-glass nodule not a precursor for adenocarcinoma in children –Irregular nodule: inflammation, scar, atelectasis 18 y/o, no pulmonary symptoms, negative history Overlapping 1.25 mm slices < -160 HU: ground glass nodule How to manage incidental 3 mm ground glass nodule? • Ignore • “Hide” in body of report body • Mention in impression, no recommendation • Recommend CT follow up • Recommend biopsy .

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Information About Lung Nodules
Information about lung nodules Introduction/procedure You have been informed that you have a nodule (or nodules) in your lung. This is a very common finding and is usually nothing to worry about. Lung nodules are often very small (too small to investigate further) and cause no symptoms. They are often found incidentally whilst having a chest x-ray or CT scan for another condition and do not affect the function of the lungs or interfere with breathing. Once discovered, it’s important to observe the appearance of the nodule(s) over time. This is done by repeating an x-ray or CT scan of your chest at certain intervals. Some nodules can be seen on chest x-ray whilst others require a CT scan to be seen clearly. The interval between the scans or x-rays is usually 3 or 6 months and is determined by your age, whether you smoke and the original size of the nodule(s). It is not the same for everyone, but we follow nationally agreed guidelines. After each scan, the images will be reviewed by the specialist chest team and the nodules measured. You will be informed of the result of the review by telephone 2-3 weeks after the scan. Most lung nodules stay exactly the same size, get smaller or even disappear over time. If a nodule has not increased in size over a series of scans or x-rays, you will be informed that no more follow up is required. Rarely a lung nodule may increase in size. If so, it’s important to determine the nature of the nodule and further investigation will be necessary.
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Cigna Medical Coverage Policies – Radiology Chest Imaging Effective November 15, 2018
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Radiation-Induced Organizing Pneumonia: a Characteristic Disease That Requires Symptom-Oriented Management
International Journal of Molecular Sciences Review Radiation-Induced Organizing Pneumonia: A Characteristic Disease that Requires Symptom-Oriented Management Keisuke Otani *,†, Yuji Seo † and Kazuhiko Ogawa † Department of Radiation Oncology, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan; [email protected] (Y.S.); [email protected] (K.O.) * Correspondence: [email protected]; Tel.: +81-6-6879-3482 † These authors contributed equally to this work. Academic Editor: Susanna Esposito Received: 30 November 2016; Accepted: 24 January 2017; Published: 27 January 2017 Abstract: Radiation-induced organizing pneumonia (RIOP) is an inflammatory lung disease that is occasionally observed after irradiation to the breast. It is a type of secondary organizing pneumonia that is characterized by infiltrates outside the irradiated volume that are sometimes migratory. Corticosteroids work acutely, but relapse of pneumonia is often experienced. Management of RIOP should simply be symptom-oriented, and the use of corticosteroids should be limited to severe symptoms from the perspective not only of cost-effectiveness but also of cancer treatment. Once steroid therapy is started, it takes a long time to stop it due to frequent relapses. We review RIOP from the perspective of its diagnosis, epidemiology, molecular pathogenesis, and patient management. Keywords: organizing pneumonia; bronchiolitis obliterans organizing pneumonia; breast cancer; corticosteroid treatment; radiation-induced organizing pneumonia 1. Introduction Pneumonia is one of the most common causes of death around the world, but various pathogeneses may be responsible. It is divided into alveolar and interstitial pneumonia, and interstitial pneumonia needs further classification [1]. Organizing pneumonia (OP) is a type of interstitial pneumonia and consists of cryptogenic organizing pneumonia (COP) and secondary organizing pneumonia (SOP) [2].
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Supplementary Material
Supplementary material Table S1. A sample of 10 anonymised chest CT reports with NLP probabilistic and binary outputs, where a binary output of 1 denotes “possible fungal” for verification using medical record review. Binary prediction Patient NLP Fungal (1=possible fungal Procedure Report text no. probability for further review, 0=else) CT Chest performed on XXXX: Clinical notes: External CT abdo found ectatic fluid filled tubular structure in RLL and pleural based opacity within lingula . ?Aetiology. PHx CMML, GVHD, immunosuppressed. Technique: Post-contrast CT chest. Comparison: Radiograph from XXXX and CT chest from XXXX. Findings: Bronchocentric consolidation, centrilobular nodules and probable mucus plugging is present in the right lower lobe (lateral basal segment) and left upper lobe (superior lingula segment). The left upper lobe consolidative changes become confluent in the periphery with some additional ground-glass change. Mild bronchiectasis in the posterobasal 1 CT Chest segment of the lower lobes. No pleural effusion. Prominent mediastinal and bilateral hilar lymph 0.81227958 1 nodes are likely reactive. Small hiatus hernia. No pericardial effusion. Flowing ossification along the right anterolateral aspects of the mid-lower thoracic vertebral bodies, consistent with DISH. Hazy increased attenuation of the small bowel mesentery (non-specific). Conclusion: Multifocal areas of consolidation and likely also mucous plugging in both lungs. The imaging findings are non- specific although infection is favoured, particularly in the setting of the patient's immunosuppression. Given the lack of significant respiratory compromise, fungal organisms require consideration (bacterial organisms thought less likely). Follow-up to radiographic resolution recommended. CT Abdomen Pelvis and High Res Chest performed on XXXX: Indication: XXyo female persistent febrile neutropaenia.
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Pulmonary Nodules and Mini-Invasive Lung Resection: Do We Have the Right “Tool” for Their Intraoperative Localization?
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Pulmonary Nodules: When to Worry, When to ‘Chill’
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BTS Guidelines for the Investigation and Management of Pulmonary Nodules
August 2015 Volume 70 Supplement 2 ThoraxAN INTERNATIONAL JOURNAL OF RESPIRATORY MEDICINE BTS Guidelines for the Investigation and Management of Pulmonary Nodules British Thoracic Society Pulmonary Nodule Guideline Development Group thorax.bmj.com tthoraxjnl_70_S2_Cover.inddhoraxjnl_70_S2_Cover.indd 1 223/05/153/05/15 110:310:31 AAMM Dr M E J Callister, Prof D R Baldwin, Dr A R Akram, Mr S Barnard, Dr P Cane, Ms J Draffan, Dr K Franks, Prof F Gleeson, Dr R Graham, Dr P Malhotra, Prof M Prokop, Dr K Rodger, Dr M Subesinghe, Mr D Waller, Dr I Woolhouse British Thoracic Society Pulmonary Nodule Guideline Development Group On behalf of the British Thoracic Society Standards of Care Committee The BTS Guideline for the Investigation and Management of Pulmonary has been endorsed by: The Royal College of Physicians, London National Lung Cancer Forum for Nurses The Royal College of Radiologists British Nuclear Medicine Society Society for Cardiothoracic Surgery in Great Britain and Ireland tthoraxjnl_70_S2_Title_Page.inddhoraxjnl_70_S2_Title_Page.indd 1 223/05/153/05/15 110:340:34 AAMM Healthcare providers need to use clinical judgement, knowledge and expertise when deciding whether it is appropriate to apply recommendations for the management of patients. The recommendations cited here are a guide and may not be appropriate for use in all situations. The guidance provided does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or
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Solitary Nodular Bronchioloalveolar Carcinoma Ofthe Lung: 1 Prediction Ofhistology at High-Resolution CT
J Korean Radiol Soc 1998; 39: 693-698 Solitary Nodular Bronchioloalveolar Carcinoma ofthe Lung: 1 Prediction ofHistology at High-Resolution CT Hyun-JungJang, M.D., Kyung Soo Lee, M.D., Yookyung Kirn, M.D. 2 Myung-HeeShin, M.D.3, In Wook Choo, M.D., SeungHoonKirn, M.D. WonJae Lee, M.D., Hong SikByun, M.D., SangJinKirn, M.D.4 Purpose : The purpose of this study is to describe the characteristic high-resol ution (HR) CT findings of solitary nodular bronchioloalveolar carcinoma (BAC) of the lung which are valuable for specific diagnosis ofthe disease. Materials and Methods : HRCT scans of 46 patients (31 with malignant and 15 with benign lesion) with a solitary pulmonary nodule seen on chest radiograph were distributed in random order and analyzed retrospectively. Two blinded observers jointly analyzed the marginal and internal characteristics of nodules as seen on HRCT, and decisions on the findings were reached by consensus. Stepwise discriminant analysis for characteristic findings ofBAC was performed. Results : The most frequent CT findings ofBAC (n= 15) were internal bubble lu cency (1 4/15, 93 %)(p=O .-OOl), area of ground-glass opacity (12/1 5, 80 % ; average 58 % of tumor volume)(p=O.OOOl), pleural tag(12/15, 80 % ; p=0.097), and lobulated and spiculated margin(8/1 5, 53 % ; p=0.459). Findings of ground-glass opacity (p=O.OOOl) and bubble lucency (p=0.0187) appeared to be discriminant in the diagnosis of BAC. Conclusion : Peripheral pulmonary nodules containing an area of ground-glass opacity associated with internal bubble-lucency are characteristic ofBAC.
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''Reversed Halo Sign''
SIGNS IN CARDIOPULMONARY IMAGING ‘‘Reversed Halo Sign’’ Christopher M. Walker, MD, Tan-Lucien Mohammed, MD, FCCP, and Jonathan H. Chung, MD Reversed halo sign Central ground-glass opacity with peripheral rim of consolidation Differential diagnosis Cryptogenic organizing pneumonia Infection Wegener granulomatosis Pulmonary infarct Sarcoidosis FIGURE 1. Reversed halo sign in a 50-year-old woman with cryptogenic organizing pneumonia. A and B, Axial and coronal images from noncontrast Radiofrequency ablation chest CT show foci of central ground-glass opacity with a circumferential halo Lymphomatoid granulomatosis of consolidation (black arrows). Appearance: The reversed halo sign (also known as the atoll sign, reverse halo sign, and the fairy ring sign) is defined by central ground-glass opacity with a surrounding halo or crescent of consolidation (Fig. 1).1 This should not be confused with the halo sign which refers to central consolidation with a surrounding halo or rim of ground-glass opacity.2 Furthermore, the reversed halo sign should be differentiated from cavitation (development of focal regions of internal gas) or pseudocavitation (likely internal bronchiolectasis described in subtypes of lung adenocarcinoma). Explanation: Pathology of the reversed halo sign in cryptogenic organizing pneumonia (COP) demonstrates alveolar septal inflammation corresponding to central ground-glass opacity and granulomatous tissue in peripheral airspaces (organizing pneumonia) in areas of peripheral consolidation.3 In patients with South American blastomycosis
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The Solitary Pulmonary Nodule: Not Always Bronchogenic Carcinoma
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