An Undergraduate level approach to lung masses with few radiographs showing common lung lesions.

1. Lung Masses
Dr. Girendra Shankar
PG Resident
Dr. R N Dash
Associate Professor
Department of Radiodiagnosis and Imaging,KIMS

5. Doubling time
If a lesion doubles in volume
>6 weeks and <16 months,
usually malignant

7. Incidence
o On routine survey, <5% are malignant nodules
o At Biopsy/Surgery, 40% of nodules are Ca, 40% Granulomas

9. o Alveolar cell ca
o Lymphoma
o Pseudolymphoma
o Inflammatory pseudotumor

11. Cavitating Nodules
o Squamous cell
(mc) o Adenocarcinoma
o Bronchoalveolar cell ca (rare)
o Hodgkin's Disease (rare)

12. Calcification of lung nodules
o Laminated: TB Granuloma
o Central or target: Histoplasmoma
o Popcorn: Hamartoma

13. Pulmonary nodules with
pneumothorax
o Osteosarcoma
o Wilm's tumor
o Eosinophilic granuloma

14. Radiological findings
o Airway obstruction
§ Atelectasis most common sign
§ No air bronchogram
§ Also post-obstructive pneumonia
o Hilar enlargement
§ From either the carcinoma itself or nodes
§ Particularly common in oat cell, uncommon in adenoca

15. CT Angiogram Sign

16. o Mediastinal node enlargement
§ Particularly anaplastic ca
o Cavitation
§ Common (2-16%)
§ Especially in squamous cell, mostly in upper lobes
§ Cavity is usually thick-walled with nodular inner margin
o Pleural involvement
§ Common: 10%
§ Hemorrhagic effusion denotes direct tumor invasion
§ Effusion carries a poor prognosis even if no malignant cells are found

18. Squamous cell ca
Central Location (2/3)
Atelectasis
"Reverse S sign of Golden”
Post-obstructive pneumonia
May cavitate
Most closely associated with smoking

20. Small cell undifferentiated=Oat Cell Carcinoma
o Appearances
§ Mediastinal adenopathy
§ Hilar mass
§ Small or invisible lung nodule
o High metastatic potential
o Rapid growth

21. Adenocarcinoma
o Usually peripheral nodule
o Found in scars
o Solitary pulmonary nodule (52%)
o Upper lobe distribution (69%)
Large cell undifferentiated (10%)
o Large peripheral mass
o Pleural involvement

25. SPOTTERS

27. Thymic Sail Sign

29. Golden S Sign

31. Hamptons Hump

33. Finger in glove sign - ABPA

35. Pneumatocele

37. Crazy Paving
Pattern -
Pulmonary
Alveolar
Protienosis

39. Cannon Ball Metastasis

41. CT Angiogram Sign

43. Pulmonary Hamartoma

45. Water Lily Sign

47. Asbestosis

49. Bulging Fissure Sign