Solitary Pulmonary Nodule

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Solitary Pulmonary Nodule
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Solitary Pulmonary Nodule (SPN)

• Smaller than 3 cm
• 2.42 cm?
• Needs to be at least 1 cm
• to be seen chest x-ray film.
• Surrounded by normal lung
• tissue and is not associated
• with any abnormality in the lung or nearby
  lymph node.

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Solitary Pulmonary Nodule (SPN)

• Pt usually asymptomatic.
• 150,000 cases are detected every year by
  incidental findings (x-ray or CT).
• Most SPNs are benign, but may indicate malignancy
  spreading from another primary location.

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Solitary Pulmonary Nodule (SPN)

• Possible causes
• Neoplasm (benign/malignant, primary/mets)
• Lymphoma, carcinoid
• Infectious
• TB, Fungi (histo, coccidio, blasto, crypto)
• Inflamatory
• RA, Wegener, Sarcoidosis
• Congenital
• AV malformation, Sequesteration, Lung cyst
• Misc
• Atelectasis, mucoid impaction, infarct, fibrosis

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Solitary Pulmonary Nodule (SPN)

• Risk of Malignancy increases with age
• 35-39 3
• 40-49 15
• 50-59 43
• 60 50
• Smoking increases risk
• Prior history of cancer
• Occupational (ship builder, other STEP 1 stuff)
• Travel (fungal causes)
• History of or exposure to TB

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Solitary Pulmonary Nodule (SPN)

• Further work-up
• CT
• Biopsy
• Bronchoscopy with transbronchial needle
  aspiration
• Transthoracic needle aspiration
• Tuberculin skin test
• Sputum culture
• PET scan
• Labs HH, Sed Rate, Liver panel, IgG/M (fungal
  causes),

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Solitary Pulmonary Nodule (SPN)

• After determining that a nodule is benign
  recommendations are
• CXR every 3 months for 1 year and then every 6
  months for another year.
• After initial 2 year period, SPNs may be observed
  yearly for up to 5 years.

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Malignant lung nodule
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Tuberculosis
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Cryptococcus
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Histoplasmosis
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Blastomycosis
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Lymphoma
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Sarcoidosis
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A-V Malformation
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Wegeners Granulomatosis
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Primary Lung Cancer
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The End

• Smokem if
• you got em.