Chapter 9 – Chest

Solitary Lung Nodule

ACR – Chest – Radiographically Detected Solitary Pulmonary Nodule

Case

Incidental, Solitary Pulmonary Nodule

Clinical:

History – As part of a General Physical Exam, a routine chest x-ray was ordered on this 53 year old male. His last physical examination was 3 years ago.  Chronic smoker.  Mild COPD. Insulin dependent diabetic.

Symptoms – Dry cough, mild chronic dyspnea. Nil acute.

Physical – Non-contributory.

DDx:

Routine screening, smoker.

Solitary pulmonary nodule detected.

Imaging Recommendation

ACR – Chest – Radiographically Detected Solitary Pulmonary Nodule, Variant 1

Chest X-ray

CT Chest without and with IV contrast

ODIN Link for Chest x-ray images, Figure 9.24A and B: https://mistr.usask.ca/odin/?caseID=20170202123906863
ODIN Link for Chest CT images, 9.24: https://mistr.usask.ca/odin/?caseID=20170202131226013
Figure 9.24A PA Chest x-ray displaying a solitary lung nodule
Figure 9.24B Lateral Chest x-ray demonstrating a solitary pulmonary nodule

Imaging Assessment

Findings:

There were changes of mild COPD.  A 2.5 – 3 cm diameter, circumscribed, opacity was seen in the right lower lobe.  The opacity overlapped the right hilum and the thoracic spine. No other findings.

Interpretation:

Solitary pulmonary nodule.  This abnormality was suspicious for a malignancy.  CT of the chest was recommended for further assessment. If concern persists for malignancy after this exam needle biopsy of the lung nodule should be considered.

Diagnosis:

Solitary Pulmonary Nodule – Suspicious for Malignancy 

Discussion:

A nodule is defined as a circumscribed opacity < 3 cm in diameter.  The differential is broad.  There are imaging features that suggest benignity, while for others there are imaging features that require imaging follow-up or biopsy.

The Fleischner Society has established nodule follow-up guidelines:

https://fleischnersociety.org

X-ray findings may include:

  • A nodule or mass is an opacity with smooth or lobulated margins.
  • The margins of the nodule or mass may be smooth, lobulated, or spiculated.
  • There may be calcification in the nodule or mass.
  • Masses may grow to invade the pleura, chest wall, hilum, mediastinum, and may cross fissures.
  • The mass may have adenopathy or pleural effusion associated with it.

Attributions

Figure 9.24A PA Chest x-ray displaying a solitary lung nodule by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.

Figure 9.24B Lateral Chest x-ray displaying a solitary lung nodule by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.