Sunday, July 30, 2006

Pulmonary nodules

This is a 44 y/o man who works here in the hospital. He is a ctually a nice guy so I'm trying not to find anything too interesting on his case.
He is very healthy and smoked a pack-a-day for ten years but quit in 1988. He had travelled to the gul area and came back with a severe gastroenteritis. It seems that it was so bad the primary team got a CT of his abdomen. He did OK but the lower cuts of the lung revealed a ~1-cm partially calcified LLL nodule. He is completely asymptomatic from a respiratory perspective. His PFTs are completely normal. We got a dedicated CT of the chest and found the following nodules: (a 9-mm RUL a ~5-mm L apical and the same LLL).
The RUL has a little bit of excentric calcium as does the LLL one. Would you PET, biopsy, watch or else?

2 comments - CLICK HERE to read & add your own!:

Jennings said...

The size of the other nodules means you'll just ignore a negative PET anyway. The other has some calcium but the way it is distributed within the nodule doesn't rule out Ca. I assume there are no nodes. I would repeat CT in 3 months and just follow if there is no chaneg in these 3 nodules. If there is increase, would PET at that point. Extra info at 3 months would be whether all 3 are growing or just the LLL nodule.

Arenberg said...

I think the more rounded nodule in the top two films (LLL) is centrally calcified, and is therefore benign. I would not follow that. The others are probably the same etiolgy, but a 6 month follow up study would be reasonable for the one non-calcificed nodule.

The Fleischner society is about to publish some recceommended guidelines for following very small (<5 mm) nodules that are so #$%^&*(*&^%$ commonly found now.

http://radiology.rsnajnls.org/cgi/content/full/237/2/395

It'll be interesting to see how much adherence there is to these guidelines which recommend no follow up on nodules < 5 mm in size for low risk patients, and less frequent follow up for others as well. Check it out.