Coin lesion

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Coin lesion

  1. 1. Coin Lesion Dr.CSBR.Prasad, M.D. CSBRP-Dec-2012
  2. 2. Coin LesionDef: Any of various solitary, round,circumscribed shadows appearing inradiographic examinations of the lungsthat are believed to be caused bytuberculosis, carcinoma, cysts, infarcts,or vascular anomalies. CSBRP-Dec-2012
  3. 3. CSBRP-Dec-2012
  4. 4. Coin Lesion CSBRP-Dec-2012
  5. 5. Risk of malignancy increases with the agePatients who are >50yrs, the probability of SPN to be malignant is 50% CSBRP-Dec-2012
  6. 6. Solitary Pulmonary NoduleCommon causes: Less common causes:• Primary lung cancers • Lymphoma• Metastases • Mesothelioma• Infections: TB, Pneumonia • Carcinoid• Pseudotumor • Chondroma • Hamartoma • Cysts – Hydatid • Rheumatoid nodule • Pulmonary sequestration • Pulmonary infarct • AV malformation CSBRP-Dec-2012
  7. 7. Solitary Pulmonary Nodule• SPN requires prompt and accurate Dx• A nodule that has not changed in size for two years is nearly always benign• Rapidly enlarging nodule suggests either infection or inflammation• CT scans are helpful in DD behaviour• SPN requires histological confirmation• If CT / biopsy fail to confirm the nature of the SPN, surgical excision should be considered CSBRP-Dec-2012
  8. 8. Solitary Pulmonary NoduleClinical features:Majority are clinically silentCoughCervical lymphadenopathyFinger clubbingSource of mets – Abdomen/Breast/TestisRash – Vasculitis CSBRP-Dec-2012
  9. 9. Chest X-rayMust be evaluated carefully:Presence of emphysema suggests a significant smoking historyAn upper lobe location would suggest a TBPresence of heart failure in a patient with a SPN at the horizontal fissure suggests a pseudotumorCalcification indicates benign lesionMalignant lesions have shaggy, spiculated or lobulated margin CSBRP-Dec-2012
  10. 10. Solitary Pulmonary Nodule Rule-1A nodule that has not changed in size for two years is nearly always benign CSBRP-Dec-2012
  11. 11. Solitary Pulmonary Nodule Rule-2Rapidly enlarging nodule would suggest either infection or inflammation Fast growing tumors are uncommon CSBRP-Dec-2012
  12. 12. Solitary Pulmonary Nodule Rule-3A nodule in a patient with a h/o smoking should be considered malignant until proven otherwise CSBRP-Dec-2012
  13. 13. Solitary Pulmonary Nodule Rule-4 Calcification suggests a benign lesionPatterns of calcification:A central nidus suggests granulomaLamination suggests granuloma – histoplasmaPop-corn pattern suggests HamartomaMultiple punctate pattern – Hamartoma / Granuloma CSBRP-Dec-2012
  14. 14. CSBRP-Dec-2012
  15. 15. Encysted effusion CSBRP-Dec-2012
  16. 16. Encysted effusion CSBRP-Dec-2012
  17. 17. E N D CSBRP-Dec-2012

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