Diagnostic Radiology/Chest Imaging/Pulmonary Nodules

1. State the definition of a solitary pulmonary nodule and a pulmonary mass
2. Name the three most common causes of a solitary pulmonary nodule
3. Name four important considerations in the evaluation of a solitary pulmonary nodule
4. Name six causes of cavitary pulmonary nodules
5. Name four causes of multiple pulmonary nodules
6. State the indications for percutaneous biopsy of a solitary pulmonary nodule
7. State the indications for percutaneous biopsy when there are multiple pulmonary nodules
8. State the complications and the frequency with which complications occur due to percutaneous lung biopsy using CT or fluoroscopic guidance
9. State the indications for chest tube placement as a treatment for pneumothorax related to percutaneous lung biopsy
10. State the role of positron emission tomography (PET) in the evaluation of a solitary pulmonary nodule

Work up of new or enlarged solitary pulmonary nodule (SPN) in Chest X-ray or SPN on CT

Perform a High Resolution CT-scan (HRCT) study

• Benign calcification or shape: No further work-up is indicated.
• Fat (with or without calcification) : No further work-up is indicated.
• Indeterminate:
  • 4–10 mm: Follow up with CT volumetrics studies in 6, 12, and 24 months.
  • >10 mm:
    • ground glass opacity with or without a solid lesion: biopsy/resect
    • solid: CT with IV contrast, PET, or Biopsy

In contrast CT, malignant lesions show an increase of greater than 15H after contrast (98% sensitive for 6-30 mm nodules)

PET with Fluorine-18-labeled fleurodeoxyglucose is 97% sensitive, and 78% specific for nodules that are larger than 10 mm

if negative: follow up in 6, 12, and 24 months

Doubling time (volume) of less than one month or longer than two years suggest a benign lesion.