Solitary pulmonary nodule

1. Solitary pulmonary nodule
Single,well-circumscribednodule seenincidentallyonCXRwithouthilarormediastinal LNs.
Differential diagnosis:
Benign Malignant
Infection: Abscess,TB, hydatid cyst Bronchogenic cancer
Inflammation:Rheumatoid nodule, wegener’s Metastasis
Vascular:Pulmonary infarction,AVM Lymphoma
Simple cyst Carcinoid
Benign neoplasm: hamartoma --
What is a potentiallybenignnodule?
1. Size < 1 cm
2. Shape:round,well-circumscribed
3. Central callcification
4. No change in2 years
5. Age < 50 years
6. Notsmoker
What is the approach to a solitary lungnodule?
1. Findan oldCXR  if the nodule notchangedin2 years  follow yearly
 if the nodule changed/new nodule/noCXRfound  godown
2. Determine risk  lowrisk  do CT Q 2 monthsfor 2 years
 intermediate risk  CT& biopsy orPET  if malignant excise
 benign F/UQ2 mnth
 highrisk  remove it
How to take a biospy insolitary lung nodule?
1. Peripheral nodule  transthoracicbiopsy
2. Central nodule bronchoscopy butopenlungbiopsyissuperior
What are the drawbacks of bronchoscopy-biopsy?
1. Non-specificresultsin10%
2. Done blindly