An Approach to the solitary pulmonary nodule.....
Differential Diagnosis:
- Malignant: can be primary (adenoCa, squamous, large cell, or small cell), or metastatic
- Infectious: Granuloma from TB or fungal infection (eg. histoplasmosis, coccidiomycosis), abscess, aspergilloma
- Vascular: arteriovenous malformation, infarction
- Inflammatory: Wegener's granulomatosis, rheumatoid nodule
- Benign neoplasm: hamartoma, lipoma
- Size greater than 3 centimeters
- spiculated border
- "eccentric" calcification pattern (see above image; calcium deposition is off-centre)
- doubling time of the nodule is between 20 and 400 days
- Clinical clues: constitutional symptoms, smoking history
- Take a good history and physical exam
- Get an old Chest X-ray
- If you susptect malignancy: Get a tissue sample with Bronchoscopy vs Video-Assisted Thorascopic Surgery vs Open Thorascopy
- approach to the solitary pulmonary nodule from NEJM.
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