Pulmonary nodule differential diagnosis: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
 
(4 intermediate revisions by the same user not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Pulmonary_nodule]]
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Pulmonary_nodule]]
{{CMG}}; {{AE}} {{Trusha}}, {{MV}}
{{CMG}}; {{AE}} {{Trusha}}, {{JE}}, {{MV}}
==Overview==
==Overview==


Line 62: Line 62:
* <5 mm [[Nodule (medicine)|nodule]]
* <5 mm [[Nodule (medicine)|nodule]]
* [[Ground glass opacification on CT|Ground glass]]
* [[Ground glass opacification on CT|Ground glass]]
[[File: CT of ground glass lung nodule.png|x200px|thumb|CT showing Ground glass opacity nodule. (Picture courtesy: [https://en.wikipedia.org/wiki/Lung_nodule Wikipedia])]]
| style="background: #F5F5F5; padding: 5px;" |[[Fat]]
| style="background: #F5F5F5; padding: 5px;" |[[Fat]]


Line 75: Line 76:
* [[Growth rate]] > 18 months
* [[Growth rate]] > 18 months
* [[Cavity]] wall thickness of 1 mm
* [[Cavity]] wall thickness of 1 mm
[[File:Pulmonary hamartoma.jpeg|x200px|thumb|CT showing Pulmonary [[hamartoma]] with well-defined smooth border. Case courtesy of Dr Domenico Nicoletti (Picture courtesy: [https://radiopaedia.org/cases/pulmonary-hamartoma-11?lang=gb Radiopaedia])]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
Line 111: Line 113:
* Single or multiple
* Single or multiple
* Small or > 2 cm of size
* Small or > 2 cm of size
[[File: Lungca.jpg|x200px|thumb|CT showing bronchogenic carcinoma. Case courtesy of Dr Ahmed Abdrabou (Picture courtesy: [https://radiopaedia.org/cases/bronchogenic-carcinoma-with-upper-lobe-collapse?lang=gb Radiopaedia])]]
| style="background: #F5F5F5; padding: 5px;" |[[Calcification]]
| style="background: #F5F5F5; padding: 5px;" |[[Calcification]]
* [[Amorphous solid|Amorphous]]
* [[Amorphous solid|Amorphous]]
Line 117: Line 120:
* Stippled or [[Eccentric Lesion|eccentric]]
* Stippled or [[Eccentric Lesion|eccentric]]
[[Cavity]]
[[Cavity]]
[[Ulcer|Ulceration]]
[[Ulcer|Ulceration]]
[[File: Lungca.jpg|x200px|thumb|CT showing bronchogenic carcinoma. Case courtesy of Dr Ahmed Abdrabou (Picture courtesy: [https://radiopaedia.org/cases/bronchogenic-carcinoma-with-upper-lobe-collapse?lang=gb Radiopaedia])]]  
[[File:Cavitatory bronchogenic lungca.jpeg|x200px|thumb|CT showing bronchogenic [[lung cancer]] with cavity Case courtesy of Dr Ahmed Abdrabou (Picture courtesy: [https://www.wikidoc.org/index.php/File:Cavitatory_bronchogenic_lungca.jpeg Radiopaedia])]]  
*  
*  
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |

Latest revision as of 00:49, 22 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2], Joanna Ekabua, M.D. [3], Maria Fernanda Villarreal, M.D. [4]

Overview

Pulmonary nodule may be differentiated according to imaging (size, border characteristics, and attenuation), histological, and clinical features, from other diseases that demonstrate similar imaging findings. Common differential diagnoses of pulmonary nodule include hamartoma, granulomas, rheumatoid nodule, and metastatic lesions.

Differentiating Pulmonary Nodule from Other Diseases

  • The table below summarizes the findings that differentiate pulmonary nodule from other conditions that cause similar radiological findings on CT scan of the chest.[1][2]
ABBREVIATIONS:N/A: Not available , SOB: Shortness of breath, M/C: Most common
Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical exam
Lab Findings CT scan Histopathology
Productive cough Hemoptysis Weight loss SOB Fever Other Auscultation Sputum analysis Nodule Nodule content Other findings
Pulmonary Nodule(benign)

[3]

- - - - -
  • N/A
  • Normal
  • Normal
CT showing Ground glass opacity nodule. (Picture courtesy: Wikipedia)
Fat

Calcification

Types:

  • Central dense nidus
  • Diffuse solid
  • Laminated
  • Popcorn
CT showing Pulmonary hamartoma with well-defined smooth border. Case courtesy of Dr Domenico Nicoletti (Picture courtesy: Radiopaedia)
  • N/A
  • N/A
Pulmonary Nodule (malignant)

[3][4]

++ ++ ++ + -
  • Normal
  • Single or multiple
  • Small or > 2 cm of size
CT showing bronchogenic carcinoma. Case courtesy of Dr Ahmed Abdrabou (Picture courtesy: Radiopaedia)
Calcification

Cavity Ulceration

CT showing bronchogenic lung cancer with cavity Case courtesy of Dr Ahmed Abdrabou (Picture courtesy: Radiopaedia)
  • Spiculated border
  • Rapid growth rate (Doubling time 1-18 months)
  • Cavity wall thickness over 15 mm
Diseases Productive cough Hemoptysis Weight loss SOB Fever Other Auscultation Sputum analysis Nodule Content Other findings Histopathology Gold standard Additional findings
Abscess

[5]

++ - - + ++
  • Vary in size
  • Round in shape
CT showing lung abscess Case courtesy of Dr Vijay Mistry (Picture courtesy: Radiopaedia)
.
Septic pulmonary

emboli

[6]

- - - ++ ++
  • N/A
  • Multiple peripheral nodules
  • Size 0.5 - 3.5 cm
  • Variable shapes
CT of a patient with angioinvasive aspergillosis Case courtesy of Dr Ahmed Abdrabou (Picture courtesy: Radiopaedia)
CT of a patient with angioinvasive aspergillosis Case courtesy of Dr Ahmed Abdrabou (Picture courtesy: Radiopaedia)
  • N/A
  • N/A
Fungal

infection

[7]

+/- + - + +
CT of a patient with angioinvasive aspergillosis Case courtesy of Assoc Prof Frank Gaillard (Picture courtesy: Creativecommons)
  • N/A
Parasites

[8]

+/- +/- +/- _ +
  • N/A
Cyst:

Coin lesion:

Microfilaria(larva) of loa loa (Picture courtesy: Creativecommons)
  • N/A
Diseases Productive cough Hemoptysis Weight loss SOB Fever Other Auscultation Sputum analysis Nodule Content Other findings Histopathology Gold standard Additional findings
Mycobacterial infections

[9][10]

+ + + ++ +/-
  • AFB+
  • Micronodules in the subpleural region and peribronchovascular interstitium
  • Fluffy upper zone shadowing
  • Cavity
CT showing cavitating lesion with air-fluid level. Case courtesy of Dr Ayush Goel (Picture courtesy: Radiopaedia)
  • N/A
Chronic inflammatory conditions

(Granulomatosis with polyangiitis)

[11]

+/- + - + -
  • N/A
  • Multiple round lesions
  • Size 0.5 - 10 cm
CT showing multiple lung nodules bilaterally Case courtesy of Dr Abdallah Al Khateeb (Picture courtesy: Radiopaedia)
Micrograph of Granulomatosis with polyangiitis (Picture courtesy: Wikipedia)
Diseases Productive cough Hemoptysis Weight loss SOB Fever Other Auscultation Sputum analysis Nodule Content Other findings Histopathology Gold standard Additional findings
Pulmonary AVMs

[12]

- +/- - + -
  • Solitary or multiple nodules
  • Round, oval, or polycyclic
  • Size 1 - 5 cm
CT showing pulmonary arteriovenous malformation Case courtesy of Dr Vikas Shah (Picture courtesy: Radiopaedia)
CT showing pulmonary arteriovenous malformation Case courtesy of Dr Vikas Shah (Picture courtesy: Radiopaedia)
  • Not done
  • Solitary rounded opacity on X-ray
X-ray showing pulmonary arteriovenous malformation Case courtesy of Dr Vikas Shah (Picture courtesy: Radiopaedia)
Pneumoconiosis + - + + -
  • Solitary or multiple nodules
  • Size 1 - 10 cm
  • In the upper lobes
  • N/A
X-ray showing pleural plaques in a patient with asbestosis (Picture courtesy: Medpix)
Pneumoconiosis due to asbestosis showing ferruginous bodies (Picture courtesy: Wikipedia)
CT scan showing multifocal areas of ground-glass opacities in a patient with hard-metal pneumoconiosis. Case courtesy of Dr Azza Elgendy (Picture courtesy: Radiopaedia)
  • N/A
ABBREVIATIONS:N/A: Not available , SOB: Shortness of breath, M/C: Most common

References

  1. Ost D, Fein AM, Feinsilver SH (2003). "Clinical practice. The solitary pulmonary nodule". N. Engl. J. Med. 348 (25): 2535–42. doi:10.1056/NEJMcp012290. PMID 12815140. Unknown parameter |month= ignored (help)
  2. McWilliams A, Tammemagi MC, Mayo JR, et. al. Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med. 2013 Sep 5;369(10):910-9. doi:10.1056/NEJMoa1214726.
  3. 3.0 3.1 Khan AN, Al-Jahdali HH, Irion KL, Arabi M, Koteyar SS (October 2011). "Solitary pulmonary nodule: A diagnostic algorithm in the light of current imaging technique". Avicenna J Med. 1 (2): 39–51. doi:10.4103/2231-0770.90915. PMC 3507065. PMID 23210008.
  4. Li J, Xia T, Yang X, Dong X, Liang J, Zhong N, Guan Y (April 2018). "Malignant solitary pulmonary nodules: assessment of mass growth rate and doubling time at follow-up CT". J Thorac Dis. 10 (Suppl 7): S797–S806. doi:10.21037/jtd.2018.04.25. PMC 5945695. PMID 29780626.
  5. Kuhajda I, Zarogoulidis K, Tsirgogianni K, Tsavlis D, Kioumis I, Kosmidis C, Tsakiridis K, Mpakas A, Zarogoulidis P, Zissimopoulos A, Baloukas D, Kuhajda D (August 2015). "Lung abscess-etiology, diagnostic and treatment options". Ann Transl Med. 3 (13): 183. doi:10.3978/j.issn.2305-5839.2015.07.08. PMC 4543327. PMID 26366400.
  6. Chang E, Lee KH, Yang KY, Lee YC, Perng RP (2009). "Septic pulmonary embolism associated with a peri-proctal abscess in an immunocompetent host". BMJ Case Rep. 2009. doi:10.1136/bcr.07.2008.0592. PMC 3029652. PMID 21686732.
  7. Chong, Semin; Lee, Kyung Soo; Yi, Chin A; Chung, Myung Jin; Kim, Tae Sung; Han, Joungho (2006). "Pulmonary fungal infection: Imaging findings in immunocompetent and immunocompromised patients". European Journal of Radiology. 59 (3): 371–383. doi:10.1016/j.ejrad.2006.04.017. ISSN 0720-048X.
  8. Kunst H, Mack D, Kon OM, Banerjee AK, Chiodini P, Grant A (June 2011). "Parasitic infections of the lung: a guide for the respiratory physician". Thorax. 66 (6): 528–36. doi:10.1136/thx.2009.132217. PMID 20880867.
  9. Ryu YJ (April 2015). "Diagnosis of pulmonary tuberculosis: recent advances and diagnostic algorithms". Tuberc Respir Dis (Seoul). 78 (2): 64–71. doi:10.4046/trd.2015.78.2.64. PMC 4388902. PMID 25861338.
  10. Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
  11. Kubaisi B, Abu Samra K, Foster CS (May 2016). "Granulomatosis with polyangiitis (Wegener's disease): An updated review of ocular disease manifestations". Intractable Rare Dis Res. 5 (2): 61–9. doi:10.5582/irdr.2016.01014. PMC 4869584. PMID 27195187.
  12. Khurshid I, Downie GH (April 2002). "Pulmonary arteriovenous malformation". Postgrad Med J. 78 (918): 191–7. PMC 1742331. PMID 11930021.