CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSISEISENBERG

1. 6Solitary Pulmonary Nodule

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig C 6-1 Tuberculoma. Single smooth, well-defined pulmonary
nodule in the left upper lobe. In the absence of a central nidus of
calcification, this appearance is indistinguishable from that of a
malignancy.

4. • Fig C 6-2 Calcified tuberculoma. (A) Frontal and (B) lateral
views of the chest show a large left lung soft-tissue mass
(arrows) containing dense central calcification.

5. • Fig C 6-3 Histoplasmoma. Solitary, sharply
circumscribed granulomatous nodule (arrows)
in the right lower lobe.

6. • Fig C 6-4 Histoplasmoma. Characteristic
central calcification in a solitary pulmonary
nodule.

7. • Fig C 6-5 Cryptococcosis. Single fairly well-
circumscribed, mass-like consolidation in the
superior segment of the left lower lobe.

8. • Fig C 6-6 Echinococcal cyst. Huge mass filling
most of the left hemithorax.

9. • Fig C 6-7 Acute lung abscess. Large right
middle lobe abscess containing an air-fluid
level (arrows) in an intravenous drug abuser.

10. • Fig C 6-8 Bronchial adenoma. Nonspecific solitary pulmonary
nodule at the left base. Note the notched indentation of the lateral
wall (arrow) of the mass. Although this “Rigler notch” sign was
initially described as being pathognomonic of malignancy, an
identical appearance is commonly seen in benign processes.

11. • Fig C 6-9 Hamartoma. (A) Frontal view of the chest
shows a large mass (arrow) in the right cardiophrenic
angle; the mass mimics a pericardial cyst or herniation
through the foramen of Morgagni, both of which tend
to occur at this site. (B) Lateral view shows the mass to
be posterior (arrows), effectively excluding the other
diagnostic possibilities. The mass is indistinguishable
from other benign or malignant processes in the lung.

12. • Fig C 6-10 Hamartoma. Well-circumscribed
solitary nodule containing characteristic irregular
scattered calcifications (popcorn pattern).

13. • Fig C 6-11 Bronchogenic carcinoma. (A)
Relatively well-defined mass. (B) Ill-defined
solitary nodule.

14. • Fig C 6-12 Metastases. (A) Solitary metastasis
(arrow). (B) Repeat examination 5 months later
shows rapid growth of the previous solitary
nodule (white arrow). There is a second huge
nodule (black arrows) that was not appreciated
on the previous examination because it projected
below the right hemidiaphragm.

15. • Fig C 6-13 Alveolar cell carcinoma. Large, well-
circumscribed tumor mass.

16. • Fig C 6-14 Carcinoid. Well-defined round mass
in the right upper lung.17

17. • Fig C 6-15 Pulmonary hematoma. After a stab
wound, a homogeneous kidney-shaped
opacity (arrow) developed in the superior
segment of the left lower lobe. There is
blunting of the left costophrenic angle.

18. • Fig C 6-16 Lipoid pneumonia. Sharply
demarcated granulomatous-lipoid mass
(arrows) simulating a neoplastic process.

19. • Fig C 6-17 Bilateral pulmonary sequestration. (A)
Frontal view of the chest shows bilateral oval, slightly
lobulated paravertebral masses (arrows) in the
juxtadiaphragmatic region. (B) Selective angiogram of a
large anomalous artery (arrow) arising from the celiac
trunk shows several branches supplying the bilateral
paravertebral masses. The venous drainage was via the
pulmonary veins.18

20. • Fig C 6-18 Pulmonary arteriovenous fistula. (A)
View of the right lung shows a round soft-tissue
8mass (straight arrows) at the left base. Feeding
and draining vessels (curved arrows) extend to
the lesion. (B) An arteriogram clearly shows the
feeding artery and draining veins (closed arrows)
associated with the arteriovenous malformation
(open arrow).

21. • Fig C 6-19 Mucoid impaction. (A) V-shaped
and (B) Y-shaped masses (arrows).

22. • Fig C 6-20 Pulmonary vein varix. Frontal chest radiograph shows a
round mass (arrows) inferior to the left hilum. The well-defined
superior border and close association with the pulmonary veins
inferiorly, as well as poor visualization on a lateral projection (not
shown), are important features suggesting the diagnosis.19

23. • Fig C 6-21 Round pneumonia. Well-defined
round mass (arrow) in the right mid-lung in
posteroanterior (A) and lateral (B) chest
radiographs that resolved completely after
antibiotic therapy.20