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Solitary Pulmonary Nodule

Solitary Pulmonary Nodule. 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

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  1. Solitary Pulmonary Nodule

  2. 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.

  3. 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.

  4. 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

  5. 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

  6. 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: H&H, Sed Rate, Liver panel, IgG/M (fungal causes),

  7. 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.

  8. Malignant lung nodule

  9. Tuberculosis

  10. Cryptococcus

  11. Histoplasmosis

  12. Blastomycosis

  13. Lymphoma

  14. Sarcoidosis

  15. A-V Malformation

  16. Wegener’s Granulomatosis

  17. Primary Lung Cancer

  18. The End • Smoke’m if you got ‘em.

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