This document discusses lung masses and summarizes key radiological findings. It notes that if a lung lesion doubles in size between 6 weeks and 16 months it is usually malignant. Common malignant lung nodules include alveolar cell carcinoma, lymphoma, and inflammatory pseudotumor. Cavitating nodules are often squamous cell carcinoma or adenocarcinoma. Calcified nodules may indicate TB granuloma, histoplasmosis, or hamartoma. Radiological signs include airway obstruction, hilar enlargement, mediastinal node enlargement, cavitation, and pleural involvement. Specific cancers like squamous cell carcinoma and small cell carcinoma have characteristic appearances and locations.

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