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{{Lung mass}}
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==Overview==
==Overview==
[[CT scan]] is the method of choice for [[imaging]] of lung mass. On [[imaging]], the evaluation of lung mass will depend on several characteristics, such as [[calcification]], margins, location, distribution, and [[attenuation]]. Further evaluation of lung mass should include other [[diagnostic]] studies such as [[bronchoscopy]], [[sputum]] [[cytology]], or [[mediastinoscopy]]. For [[occult]] [[disease]] and assessment of [[malignancy]], additional [[Test|tests]] such as [[PET scan]] may also be done.


Computed tomography is the method of choice for the evaluation of lung mass. The evaluation of lung mass will depend on several characteristics, such as: calcification, margins, location, distribution, and attenuation. Further evaluation of lung mass, should include other diagnostic studies, such as: bronchoscopy, sputum cytology, or mediastinoscopy. Other imaging study useful for the malignancy evaluation of lung mass is [[PET]] scanning, which may be helpful for the detection of occult disease and malignancy assessment.<ref name="pmid19835344">{{cite journal |vauthors=Albert RH, Russell JJ |title=Evaluation of the solitary pulmonary nodule |journal=Am Fam Physician |volume=80 |issue=8 |pages=827–31 |year=2009 |pmid=19835344 |doi= |url=}}</ref>
==Imaging==
On [[imaging]], lung mass can be divided into the following two categories:<ref name="pmid19835344">{{cite journal |vauthors=Albert RH, Russell JJ |title=Evaluation of the solitary pulmonary nodule |journal=Am Fam Physician |volume=80 |issue=8 |pages=827–31 |year=2009 |pmid=19835344 |doi= |url=}}</ref>


==Imaging==
'''1. Hyperdense Pulmonary Mass'''
Lung mass can be divided into 2 categories:
 
:*'''Hyperdense pulmonary mass'''
*Hyperdense pulmonary mass is defined as a pulmonary mass with internal [[calcification]].
:*'''Cavitating pulmonary mass'''
*The most common causes of hyperdense pulmonary mass are [[granuloma]] (most common), [[Lung|pulmonary]] [[hamartoma]], [[bronchogenic carcinoma]], [[carcinoid tumors]], and [[Lung|pulmonary]] [[Metastasis|metastases]].


'''Hyperdense pulmonary mass'''
'''2. Cavitating Pulmonary Mass'''
*Hyperdense pulmonary mass is defined as a pulmonary mass with internal calcification
*Cavitating pulmonary mass is defined as a [[gas]]-filled area of the [[lung]] in the center of a [[nodule]], mass, or area of [[Consolidation (medicine)|consolidation]].
*The most common causes of hyerdense pulmonary mass, include: granuloma (most common), pulmonary hamartoma, bronchogenic carcinoma, carcinoid tumors, and pulmonary metastases.  
*Cavitating pulmonary mass is also characterized by a thick wall (must be greater than 2 - 5 mm).
*The most common causes of cavitating pulmonary mass include [[malignancies]], [[infections]], [[inflammation]] processes, and [[congenital malformations]].


'''Cavitating pulmonary mass'''
* The table below summarizes the most common causes of cavitating pulmonary mass:
*Cavitating pulmonary mass is defined as a gas-filled area of the lung in the center of a nodule, mass or area of consolidation
*It is also characterized by a thick wall (must be greater than 2-5 mm)
*The most common causes of cavitating pulmonary mass, include malignancies, infections, inflammation processes, and congenital malformations.
*The table below summarizes the most common causes of cavitating pulmonary mass
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
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! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|'''Description'''}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|'''Description'''}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Malignancy
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Cancer|Malignancy]]
| style="padding: 5px 5px; background: #F5F5F5;" |  
| style="padding: 5px 5px; background: #F5F5F5;" |
Cancer
*Primary [[bronchogenic carcinoma]] (especially [[squamous cell carcinoma]])
*Primary bronchogenic carcinoma(especially squamous cell carcinoma)
*Cavitating [[Pulmonary metastasis|pulmonary metastases]] (especially [[squamous cell carcinoma]], [[Gastrointestinal tract|gastrointestinal]] [[adenocarcinoma]], [[sarcoma]])
*Cavitating pulmonary metastases (especially squamous cell carcinoma, GI adenocarincoma, sarcoma)
| style="padding: 5px 5px; background: #F5F5F5;" |  
| style="padding: 5px 5px; background: #F5F5F5;" |  
Cancer
*Thick wall  
*Thick wall  
*Irregular shape
*Irregular shape
*Disort of adjacent structures
*Causes distortion of adjacent structures
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Infection
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Infection]]
| style="padding: 5px 5px; background: #F5F5F5;" |  
| style="padding: 5px 5px; background: #F5F5F5;" |  
*Pulmonary bacterial abscess/cavitating pneumonia
*Pulmonary [[Bacteria|bacterial]] [[abscess]]/cavitating [[pneumonia]]
*Empyema
*[[Empyema]]
*Post-pneumonic pneumatocoele
*Post-[[Pneumonia|pneumonic]] [[pneumatocele]]
*Septic pulmonary emboli
*[[Sepsis|Septic]] [[Pulmonary embolism|pulmonary emboli]]
*Pulmonary coccidioidomycosis
*[[Lung|Pulmonary]] [[coccidioidomycosis]]
*Pulmonary actinomycosis / thoracic actinomycosis
*[[Lung|Pulmonary]] [[actinomycosis]]/[[Chest|thoracic]] [[actinomycosis]]
*Pulmonary nocardiosis
*[[Lung|Pulmonary]] [[nocardiosis]]
*Melioidosis
*[[Melioidosis]]
*Pulmonary cryptococcosis
*[[Lung|Pulmonary]] [[cryptococcosis]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
Abscess:
'''Abscess''':
*Round in all projections
*Round in all projections
*Abruptly interrupts bronchovascular structures
*Abruptly interrupts bronchovascular structures
*May form a acute angle with the costal surface / chest wall
*May form an acute angle with the [[costal]] surface/[[chest wall]]
*Abscesses have thick irregular walls
*[[Abscess|Abscesses]] have thick irregular walls
*Abscesses usually have an acute angle (claw sign)
*[[Abscess|Abscesses]] usually have an acute angle (claw sign)
Empyema:
 
'''Empyema''':
*Smoother margins
*Smoother margins
*Lentiform shape
*Lentiform shape
*Distort and compresses adjacent lung  
*Distort and compresses adjacent [[lung]]
*Empyemas have obtuse angles
*[[Empyema]] has obtuse angles
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |  
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |  
Non-infectious
Non-infectious
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |  
*Granulomatosis with polyangitis
*[[Granulomatosis with polyangiitis|Granulomatosis with polyangitis]]
*Rheumatoid nodules
*[[Rheumatoid nodule|Rheumatoid nodules]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*May be single or multiple
*May be single or multiple
*Size ranges from 0.5-7 cm 3,5
*Size ranges from 0.5 - 7 cm
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |  
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |  
Vascular
[[Vascular]]
| style="padding: 5px 5px; background: #F5F5F5;" | 
*Pulmonary infarct
| style="padding: 5px 5px; background: #F5F5F5;" |  
| style="padding: 5px 5px; background: #F5F5F5;" |  
*Consolidation with internal air lucencies,
*[[Pulmonary infarction|Pulmonary infarct]]
*"Bubbly consolidation"; this represent non-infarcted aerated lung parenchyma
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Consolidation (medicine)|Consolidation]] with internal air lucencies
*"Bubbly [[Consolidation (medicine)|consolidation]]"; this represents non-[[Infarction|infarcted]] aerated [[lung]] [[parenchyma]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |  
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |  
Trauma
[[Physical trauma|Trauma]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |  
*Pneumatocoeles
*[[Pneumatocele|Pneumatoceles]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |  
*Smooth inner margins
*Smooth inner margins
*Contain little if any fluid  
*Contain little if any [[fluid]]
*Wall (if visible) is thin and regular
*Wall (if visible) is thin and regular
*Persist despite absence of symtpoms
*Persist despite absence of [[Symptom|symptoms]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Congenital
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Congenital disorder|Congenital]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |  
*Congenital cystic adenomatoid malformation (CCAM)
*[[Congenital cystic adenomatoid malformation|Congenital cystic adenomatoid malformation (CCAM)]]
*Pulmonary sequestration
*[[Pulmonary sequestration]]
*Bronchogenic cyst
*[[Bronchogenic cyst]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |  
*Radiological features vary according to disease  
*[[Radiological]] features vary according to the [[disease]]
*To learn more about congenital lung cavitations, click in the blue links.
|}
|}
==Imaging Evaluation==
==Imaging Evaluation==
The evaluation of lung mass will depend on 5 characteristics: calcification patterns, size, location, margins, and attenuation.
The evaluation of lung mass depends on the following 5 characteristics:<ref name="pmid7208937">{{cite journal |vauthors=Kundel HL |title=Predictive value and threshold detectability of lung tumors |journal=Radiology |volume=139 |issue=1 |pages=25–9 |year=1981 |pmid=7208937 |doi=10.1148/radiology.139.1.7208937 |url=}}</ref><ref name="pmid21697415">{{cite journal |vauthors=Hochhegger B, Marchiori E, Sedlaczek O, Irion K, Heussel CP, Ley S, Ley-Zaporozhan J, Soares Souza A, Kauczor HU |title=MRI in lung cancer: a pictorial essay |journal=Br J Radiol |volume=84 |issue=1003 |pages=661–8 |year=2011 |pmid=21697415 |pmc=3473490 |doi=10.1259/bjr/24661484 |url=}}</ref>  
* '''Calcification:''' Calcification patterns are commonly seen in granulomatous disease and hamartomas. They are normally a sign of benign lung mass. The characteristic benign calcification patterns of lung mass, include:
* '''Calcification:''' [[Calcification]] patterns are commonly seen in [[granulomatous]] [[disease]] and [[hamartomas]]. They are normally a sign of [[benign]] lung mass. The characteristic [[benign]] [[calcification]] patterns of lung mass include:
:*Diffuse
**[[Diffuse]]
:*Central
**[[Central]]
:*Laminated
**Laminated
:*Popcorn
**[[Popcorn lung disease|Popcorn]]
* '''Size:''' Any area of pulmonary opacification that measures more than 30 mm (3cms)
* '''Size:''' Any area of [[Lung|pulmonary]] opacification that measures more than 30 mm (3 cm) has to be evaluated to determine the [[histology]] of the [[Tissue (biology)|tissue]].
 
* '''Location:''' Common locations of lung mass are [[pleural]], endobronchial, and [[parenchymal]].
* '''Location:''' Common '''l'''ocation of lung mass, include pleural, endobronchial, and parenchymal
* '''Margins:''' The different types of margins for lung mass include [[Lobule|lobulated]] or scalloped margins and smooth margins. The [[Lobule|lobulated]] or scalloped margins are associated with intermediate [[malignancy]] probability whereas smooth margins are associated with [[benign]] nature of lung mass.
 
* '''Attenuation:''' Lung mass may have different types of [[attenuation]]. Common types of [[attenuation]] are [[solid]] ([[malignancy]] rate of only 7%), [[Calcified lesion|calcified]], partly solid ([[malignancy]] rate of 63%), and [[Ground glass opacification on CT|ground glass]] ([[malignancy]] rate of 18%).
* '''Margins:''' Different types of margins for lung mass, include:
:*Lobulated or scalloped margins
::*Intermediate malignancy probability
:*Smooth margins
:*:Associated with benignancy 
 
'''Attenuation'''
*Different types of attenuation for lung mass, include:
*Solid
:*Malignancy rate of only 7%
*Calcified
*Partly solid
:*Malignancy rate of 63%
*Ground glass
:*Malignancy rate of 18%
 
===Plain Radiograph===
 
*On plain radiograph, characteristic findings of lung mass, include:<ref name="pmid7208937">{{cite journal |vauthors=Kundel HL |title=Predictive value and threshold detectability of lung tumors |journal=Radiology |volume=139 |issue=1 |pages=25–9 |year=1981 |pmid=7208937 |doi=10.1148/radiology.139.1.7208937 |url=}}</ref>  
:*Rounded or spiculated mass
:*Bulky hilum (representing the tumor and local nodal involvement)
:*Lobar collapse
:*[[Cavitation]] may be seen as an air-fluid level
:*Pleural effusion
 
===CT===
*Computed tomography is the method of choice for the evaluation of lung mass
*On CT scan, characteristic findings of lung mass, include:
:*Single pulmonary nodule or mass
:*Localized area of parenchymal consolidation
:*Bubble-like areas of low attenuation within the mass are a characteristic finding
:*Hilar and mediastinal lymphadenopathy is uncommon
:*Persistent peripheral consolidation
 
===MRI===
*On MRI, there are no characteristic findings of lung mass<ref name="pmid21697415">{{cite journal |vauthors=Hochhegger B, Marchiori E, Sedlaczek O, Irion K, Heussel CP, Ley S, Ley-Zaporozhan J, Soares Souza A, Kauczor HU |title=MRI in lung cancer: a pictorial essay |journal=Br J Radiol |volume=84 |issue=1003 |pages=661–8 |year=2011 |pmid=21697415 |pmc=3473490 |doi=10.1259/bjr/24661484 |url=}}</ref>
*MRI may be helpful for the assessment of mediastinal lymph nodes and diagnose distant metastasis (malignant lung masses)
 
==Gallery==
===Plain Radiograph===
<div align="left">
<gallery heights="175" widths="175">
Image:Golden-s-sign marked.jpg|'''Golden "S" Sign''' (or reverse "S" sign of Golden) : right upper lobar collapse (the right upper lobe appearing dense and shifting medially and upwards, with a central mass expanding the hilum
Image:Cavitating-lung-cancer.jpg|'''Squameous cell lung cancer''': lung cavitating mass left upper lobe adjacent to the oblique fissure.  The prominent air-fluid level is best seen on the lateral radiograph
Image:Luftsichel-sign-in-lung-cancer.jpg|'''Luftsichel sign''': curvilinear opacity at the left apex represents compensatory hyperinflation of the left lower lobe
Image:Pulmonary-coin-lesion.jpg|'''Coin lesion sign''': round or oval, well-circumscribed lesion, compatible with primary lung cancer
</gallery>
</div>
 
===CT===
====Malignant Lung Mass====
<div align="left">
<gallery heights="175" widths="175">
Image:Bronchogenic-carcinoma-with-upper-lobe-collapse.jpg|'''Bronchogenic lung carcincoma''': upper lobe collapse
Image:Bronchogenic-carcinoma-with-lymphangitic-spread.jpg|'''Bronchogenic lung carcincoma''': upper lobe with lymphangitic spread
Image:Adenocarcinoma-of-lung-1.jpg| '''Adenocarcinoma of the lung''': ground-glass attenuation corresponds to a lepidic growth pattern and the solid component correspond to invasive patterns.
Image:Lung-squamous-cell-carcinoma.jpg|'''Squamous cell lung carcinoma''': Peripheral squamous cell lung carcinoma may be seen as a solid nodule/mass with or without an irregular border. The irregular margin can be attributed to a desmoplastic reaction or infiltrative growth
</gallery>
</div>
====Benign Lung Mass====
<div align="left">
<gallery heights="175" widths="175">
Image:Wegener-granulomatosis-3.jpg|'''Wegener granulomatosis'''
</gallery>
</div>


==References==
==References==
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Latest revision as of 17:34, 21 June 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2] Akshun Kalia M.B.B.S.[3]

Overview

CT scan is the method of choice for imaging of lung mass. On imaging, the evaluation of lung mass will depend on several characteristics, such as calcification, margins, location, distribution, and attenuation. Further evaluation of lung mass should include other diagnostic studies such as bronchoscopy, sputum cytology, or mediastinoscopy. For occult disease and assessment of malignancy, additional tests such as PET scan may also be done.

Imaging

On imaging, lung mass can be divided into the following two categories:[1]

1. Hyperdense Pulmonary Mass

2. Cavitating Pulmonary Mass

  • The table below summarizes the most common causes of cavitating pulmonary mass:
Cavitating causes Conditions Description
Malignancy
  • Thick wall
  • Irregular shape
  • Causes distortion of adjacent structures
Infection

Abscess:

  • Round in all projections
  • Abruptly interrupts bronchovascular structures
  • May form an acute angle with the costal surface/chest wall
  • Abscesses have thick irregular walls
  • Abscesses usually have an acute angle (claw sign)

Empyema:

  • Smoother margins
  • Lentiform shape
  • Distort and compresses adjacent lung
  • Empyema has obtuse angles

Non-infectious

  • May be single or multiple
  • Size ranges from 0.5 - 7 cm

Vascular

Trauma

  • Smooth inner margins
  • Contain little if any fluid
  • Wall (if visible) is thin and regular
  • Persist despite absence of symptoms
Congenital

Imaging Evaluation

The evaluation of lung mass depends on the following 5 characteristics:[2][3]

References

  1. ↑ Albert RH, Russell JJ (2009). "Evaluation of the solitary pulmonary nodule". Am Fam Physician. 80 (8): 827–31. PMID 19835344.
  2. ↑ Kundel HL (1981). "Predictive value and threshold detectability of lung tumors". Radiology. 139 (1): 25–9. doi:10.1148/radiology.139.1.7208937. PMID 7208937.
  3. ↑ Hochhegger B, Marchiori E, Sedlaczek O, Irion K, Heussel CP, Ley S, Ley-Zaporozhan J, Soares Souza A, Kauczor HU (2011). "MRI in lung cancer: a pictorial essay". Br J Radiol. 84 (1003): 661–8. doi:10.1259/bjr/24661484. PMC 3473490. PMID 21697415.

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