2. INTRODUCTION
Solitary pulmonary nodule (SPN) is defined as a
• relatively well defined
• round or oval pulmonary parenchymal lesion
• equal to or smaller than 30 mm in diameter.
• Completely surrounded by pulmonary parenchyma and/or visceral
pleura.
• Not associated with lymphadenopathy, atelectasis, or pneumonia.
9. MORPHOLOGICAL CHARACTERISTICS OF SPN
1. SIZE
• Size less than 9 mm is difficult to appreciate on CXR, but readily seen
on CT
DIAMETER MALIGNANCY RATE
<1 CM 35%
1-2 CM 50%
2-3 CM 80%
>3 CM 97%
10. 2. SHAPE
• CARCINOMAS: Irregular/Lobulated/Notched
Lobulation occurs in 25% of benign nodules
• BENIGN: ROUND/OVAL/SMOOTH
(SCARS/AREAS OF ATELECTASIS MAY APPEAR INEAR OR ANGULAR)
11. 3. LOCATION
• CENTRAL TUMORS: SMALL CELL CA, SQUAMOUS CELL CA
• PERIPHERAL TUMORS: ADENO CA, LARGE CELL CA
• METASTASIS USUALLY BASAL AND SUBPLEURAL
• BENIGN LESIONS ARE EQUALLY DISTRIBUTED THROUGHOUT THE
LUNG
12. 4. EDGE
• MALIGNANT: IRREGULAR/SPICULATED/LOBULATED
(radial extension of the tumor cells along the lymphatics, Small airways
or blood vessels)
• BENIGN: SMOOTH/SHARP
Metastases and carcinoid tumors have sharp, smooth edges
21% of well defined nodules are malignant.
13.
14.
15. CORONA RADIATA/ CORONA MALIGNA
• Presence of speculation associated with anterior nodule or mass.
• Fine, linear strands extending outward due to fibrosis surrounding the
tumor/ Desmoplastic reaction
18. HALO SIGN
• Halo of ground glass opacity surrounding anterior nodule
• Seen in
Leukemic patients with invasive aspergillosis due to haemorrage
BAC due to lepidic spread of tumor
Wegeners granulomatosis
Tuberculoma
26. GRANULOMA
• Commonest are Tuberculomas
• Single
• 1-3 CM in diameter
• Well defined, Smooth, Regular Outline
• Commonest location: Close to pleural surface
• Cavitation: Rare
27.
28. PULMONARY HAMARTOMA
• Benign Pulmonary mass containing connective tissue, cartilage, fat,
smooth muscle, marrow and bone
• Most common location- periphery of the lung
• Chest x ray- spherical, lobulated, well defined nodule
• Popcorn like calcification
Fat density within mass is a diagnostic feature
29.
30. AVM
• X ray- Well circumscribes lesion with lobulated outline
• Feeding vessels and draining vein can be seen
• PULMONARY ANGIOGRAPHY IS RARELY INDICATED
31.
32. VANISHING TUMOR
• Sharply marginated collection of pleural fluid contained either within
an interlobar pulmonary fissure or in subpleural location adjacent to
anterior fissure.
• Can occur on minor fissure, oblique fissure.
• Most of them are <4 CMS
33. ROUND PENUMONIA
• Inflammatory pseudotumor
• Sometimes pneumonic consolidation assumes anterior shape and
density similar to pulmonary neoplasm
• Careful study reveals irregular margin and air bronchogram
• Common in children
• May persist after recovery from infection
