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Evaluation of solitary pulmonary nodule detected during computed tomography examination.

Choromańska A, Macura KJ - Pol J Radiol (2012)

Bottom Line: The solitary pulmonary nodule (SPN) has always been a diagnostic challenge for the radiologists.Currently, with increased utilization of computed tomography (CT) greater number of nodules is being discovered, with numerous indeterminate lesions, which frequently cannot be immediately classified into benign or malignant category.In this article we review the imaging features of benign and malignant round opacities; we demonstrate currently used standards and also more advanced techniques that are helpful in evaluating SPNs such as contrast-enhanced CT, PET/CT imaging and also pathologic sampling with biopsy or surgical resection.We also summarize the methods of evaluating and managing SPNs based on the latest guidelines from the Fleischner Society and American College of Chest Physicians.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Military Institute of Medicine, Warsaw, Poland.

ABSTRACT
The solitary pulmonary nodule (SPN) has always been a diagnostic challenge for the radiologists. Currently, with increased utilization of computed tomography (CT) greater number of nodules is being discovered, with numerous indeterminate lesions, which frequently cannot be immediately classified into benign or malignant category.In this article we review the imaging features of benign and malignant round opacities; we demonstrate currently used standards and also more advanced techniques that are helpful in evaluating SPNs such as contrast-enhanced CT, PET/CT imaging and also pathologic sampling with biopsy or surgical resection.We also summarize the methods of evaluating and managing SPNs based on the latest guidelines from the Fleischner Society and American College of Chest Physicians.

No MeSH data available.


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Benign pulmonary nodule with central calcification due to prior histoplasma infection.
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f7-poljradiol-77-2-22: Benign pulmonary nodule with central calcification due to prior histoplasma infection.

Mentions: The presence of particular types/patterns of calcification within a nodule can help to distinguish a benign lesion from a malignant one. The best imaging tool to detect intranodular calcification is thin-section CT (without contrast enhancement) which is more sensitive than standard radiography and also allows for quantitative assessment of calcification [3]. Other methods that can be used to evaluate the presence of calcifications are low-kilovoltage radiography and chest fluoroscopy, but overall thin-section MDCT is the method of choice. The benign patterns of calcifications commonly involve: central, diffuse solid, laminated (Figure 6) and “popcorn-like” appearance. The first three types usually represent the granulomas of various origin [14] and can be associated with prior infections, for example histoplasmosis (Figures 7, 8) or tuberculosis [3]. The last pattern – “popcorn-like” calcifications is diagnostic for hamartoma [15]. Unfortunately, sometimes the lung metastases from chondrosarcomas or osteosarcomas can demonstrate “benign-patterns” of calcification [16,17]. This is where the clinical history is very important and can help make the correct diagnosis. Calcifications can also be detected in malignant lesions, in up to 13% of cancers [18] and 33% of carcinoids [19]. Malignancies usually tend to present different patterns of calcifications, such as amorphous, stippled or eccentric (Figure 9).


Evaluation of solitary pulmonary nodule detected during computed tomography examination.

Choromańska A, Macura KJ - Pol J Radiol (2012)

Benign pulmonary nodule with central calcification due to prior histoplasma infection.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3403798&req=5

f7-poljradiol-77-2-22: Benign pulmonary nodule with central calcification due to prior histoplasma infection.
Mentions: The presence of particular types/patterns of calcification within a nodule can help to distinguish a benign lesion from a malignant one. The best imaging tool to detect intranodular calcification is thin-section CT (without contrast enhancement) which is more sensitive than standard radiography and also allows for quantitative assessment of calcification [3]. Other methods that can be used to evaluate the presence of calcifications are low-kilovoltage radiography and chest fluoroscopy, but overall thin-section MDCT is the method of choice. The benign patterns of calcifications commonly involve: central, diffuse solid, laminated (Figure 6) and “popcorn-like” appearance. The first three types usually represent the granulomas of various origin [14] and can be associated with prior infections, for example histoplasmosis (Figures 7, 8) or tuberculosis [3]. The last pattern – “popcorn-like” calcifications is diagnostic for hamartoma [15]. Unfortunately, sometimes the lung metastases from chondrosarcomas or osteosarcomas can demonstrate “benign-patterns” of calcification [16,17]. This is where the clinical history is very important and can help make the correct diagnosis. Calcifications can also be detected in malignant lesions, in up to 13% of cancers [18] and 33% of carcinoids [19]. Malignancies usually tend to present different patterns of calcifications, such as amorphous, stippled or eccentric (Figure 9).

Bottom Line: The solitary pulmonary nodule (SPN) has always been a diagnostic challenge for the radiologists.Currently, with increased utilization of computed tomography (CT) greater number of nodules is being discovered, with numerous indeterminate lesions, which frequently cannot be immediately classified into benign or malignant category.In this article we review the imaging features of benign and malignant round opacities; we demonstrate currently used standards and also more advanced techniques that are helpful in evaluating SPNs such as contrast-enhanced CT, PET/CT imaging and also pathologic sampling with biopsy or surgical resection.We also summarize the methods of evaluating and managing SPNs based on the latest guidelines from the Fleischner Society and American College of Chest Physicians.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Military Institute of Medicine, Warsaw, Poland.

ABSTRACT
The solitary pulmonary nodule (SPN) has always been a diagnostic challenge for the radiologists. Currently, with increased utilization of computed tomography (CT) greater number of nodules is being discovered, with numerous indeterminate lesions, which frequently cannot be immediately classified into benign or malignant category.In this article we review the imaging features of benign and malignant round opacities; we demonstrate currently used standards and also more advanced techniques that are helpful in evaluating SPNs such as contrast-enhanced CT, PET/CT imaging and also pathologic sampling with biopsy or surgical resection.We also summarize the methods of evaluating and managing SPNs based on the latest guidelines from the Fleischner Society and American College of Chest Physicians.

No MeSH data available.


Related in: MedlinePlus