7. 1-Size : Nodule versus mass
-Rounded well-defined opacity < 3 cm
-If > 3 cm = mass
2-Growth : Doubling time
< 1 month = inflammatory
> 15 months = benign
1-15 months = further evaluation
8. **N.B. : Follow up recommendations for noncalcified nodules in
patients older than 35 years without a history of malignancy , a high
risk patient is defined as a patient with a history of smoking or other
risk factors for lung cancer
1-Nodule <or= 4 mm :
-Low risk : No follow up
-High risk : at least one follow up at 12 months , if unchanged , no
further follow up
2-Nodule > 4 mm and <or= 6 mm :
-Low risk : at least one follow up at 12 months , if unchanged , no
further follow up
-High risk : at least 2 follow up at 6-12 months and 18-24 months if no
change
3-Nodules > 6 mm and <= 8 mm :
-Low risk : at least 2 follow up at 6-12 months and 18-24 months if no
change
-High risk : at least 3 follow up at 3-6 month , 9-12 and 24 months if no
change
4-Nodule > 8 mm :
-Regardless of risk , either PET , biopsy , or at least 3 follow ups at 3 ,
9 & 24 months
9. 3-Calcification :
-Calcification is more in benign lesions
-Mets >>> no calcium
4-Margin :
-Smooth = benign lesions
-Speculated (ill-defined) = malignant lesions
-N.B. : Smooth well-defined margins , if no
calcifications , suspicious of metastases
11. 6-Other Signs :
a) Pleural tail = malignancy
b) Satellite nodules surrounding a dominant
nodule = granulomatous
c) Feeding & draining vessels entering the
hilar aspect of a nodule = AVM
d) Halo sign (ground glass veiling around
the nodule) = lesion with angioinvasive
character , aspergillosis
19. 2-Tuberculoma :
-The same as hamartoma
-Differential Diagnosis from Hamartoma :
a) Site :
-Tuberculoma is more in the apex of the upper
lobe and apex of the lower lobe
-Hamartoma can occur at any site
b) Multiplicity :
-More in hamartoma
20. There is a well defined round lesion in left midzone, the lesion shows
flecks of calcific foci, the two small white arrows point to the well
defined borders with no evidence of malignancy
23. 3-Carcinoid :
a) Centrally located carcinoid, 80% :
-Endobronchial mass
-Segmental or lobar collapse (most common
finding)
-There is often marked homogeneous contrast
enhancement due to high vascularity
b) Peripherally located carcinoid, 20% :
-Pulmonary nodule range around 10-30mm
-May enhance with contrast
24.
25.
26. CXR shows complete collapse of the left lower , CT shows a
hyperattenuating nodule (126 HU) within the left main bronchus
34. 6-Fungus :
-Focal intracavitary mass (3-6 cm)
-Upper lobes
-Air surrounds the aspergilloma >> Monod
sign
-Small area of consolidation around the
cavity
-Adjacent pleural thickening
35.
36.
37.
38.
39. 7-AVM :
-Lower lobes
-Sharply defined lobulated / rounded mass
lesion + feeding artery & draining vein
-Cord like bands from the lesion to hilum
43. 8-Hematoma :
-Peripheral smooth and well-defined , 2-6
cm
-Slow resolution over several weeks
9-Septic Emboli :
-Septic emboli usually present as multiple ill-
defined nodules
-In about 50% cavitation is seen
45. Multiple Pulmonary Nodules :
1-Metastases (Most common ever)
2-Septic emboli
3-Wegner’s granulomatosis
4-Rheumatoid Nodules
5-Abscesses , commonly with staph , cavitation is
common , no calcification
6-Sarcoidosis
7-Caplan’s Syndrome
8-AVM , multiple in 33 %
46. b) Masses : Solid or Cystic
1-Solid :
-Carcinoma or Metastases
-Comment on :
*Lymph nodes
*Chest wall invasion (rib destruction)
*Mediastinal invasion
*Pleural effusion
*Diaphragm
*Upper abdomen (Liver , suprarenal)
47.
48.
49. -N.B. :
*Multiple spiculated masses >> lymphoma
or metastases
*Mets of bronchogenic >> brain &
suprarenal
*Big mass in a child = neuroblastoma
50. 2-Cystic : Hydatid cyst
-Water density
-Multiple cysts in the wall of a large cyst
-Rupture in a bronchus = fluid level (wavy) ,
water lily sign
-Meniscus sign = rupture between the layers
of the cyst
-Rupture in a pleura = hydropneumothorax
51.
52. Air meniscus in the superior aspect of the lesion as a result of the enlarging
cyst communicating with an adjacent bronchiole
58. 2-Bulla :
-Air filled cavity + lung shows
emphysematous changes
-Peripheral
-Its wall has no relation to chest wall
-May be secondary infected
-If ruptured >>> pneumothorax
59.
60.
61.
62. 3-Cyst : Pneumatocele :
-Centered (caused by prior lung trauma or
infection)
-Air filled cavity , thin walled +/- air fluid level
(secondary infected)
**N.B. : Intracavitary Lesions >>
-Cavity inside it a ball :
1-Fungal ball
2-Tumor (non-uniform wall with lymphadenopathy)
3-Hydatid Cyst
4-Blood Clot
63. **N.B.
D.D. of solitary cavitary lesion :(cancer or infection)
1-Primary bronchogenic carcinoma (both squamous cell &
adenocarcinoma can cavitate , squamous cell cavitates
more frequently , small cell carcinoma is never known to
cavitate)
2-T.B. (classically produces an upper lobe cavitation)
D.D. of multiple cavitary lesions (typically vascular or
spread through the vascular system)
1-Septic emboli
2-Vasculitis (including Wegner granulomatosis which is
specially prone to cavitate)
3-Metastases (squamous cell carcinoma and uterine
carcinosarcoma are known to cavitate)
64. Post infectious pneumatocele, the initial chest x-ray shows
consolidation in the right lung, follow up chest done, when the
patient was asymptomatic, shows multiple thin walled lucencies in
the right lung
65. (a) Initial CXR shows a dense right upper lobe consolidation, (b) CXR a
week later shows a round cyst with thin walls in the right upper lobe