Pulmonary nodule

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Round focus projected onto the 5th and 6th ribs on the left

In the context of chest x-ray diagnostics, a pulmonary nodule is defined as a largely rounded shadow in two planes with a diameter of ≤ 30 mm. If the findings are> 30 mm, it is referred to as a mass.

causes

There are a wide variety of diseases and abnormalities that can cause pulmonary nodule. Typical causes include:

rating

In the case of a single round nodule (solitary), the average probability of the presence of bronchial carcinoma is given as 40%. This probability depends on the age of the patient and the size of the nodule. The larger the nodule, the more likely it is that bronchial carcinoma is present.

A comparison with an X-ray taken earlier (if available) can be very helpful. If this previous image is more than 2 years old and the nodule has not changed noticeably since then, bronchial carcinoma is unlikely.

Fleischner criteria

In 2005, recommendations for the treatment of pulmonary nodules were published if they were discovered by chance. These criteria are a guide to the procedure.

In 2017 the updated criteria of the Fleischner Society were published.

Solid round stoves
Round hearth size Pat. Low risk Patient high risk
<6 mm singular no follow-up check optional control in 12 months
multiple no follow-up check optional control in 12 months
6 - 8 mm singular Check-up in 6-12 months, then consider CT in 18-24 months Check-up in 6-12 months and after 18-24 months
multiple Check-up in 3-6 months, consider checking after 18-24 months Check-up in 3-6 months and after 18-24 months
> 8 mm singular Consider checking in 3 months, further diagnostics using PET / CT or biopsy Consider checking in 3 months, further diagnostics using PET / CT or biopsy
multiple Check-up in 3-6 months, consider checking after 18-24 months Check-up in 3-6 months and after 18-24 months
Sub-solid round herd
Round hearth size Frosted glass stoves partially solid multiple
<6mm No follow-up check No follow-up check Check-up after 3-6 months, if the results are stable, consider checking after 2 and 4 years
≥ 6mm Check-up after 6-12 months, if persistence check every 2 years for 5 years Check-up after 3-6 months, if persistence annual check-up for 5 years Follow-up after 3-6 months, subsequent management based on the most suspicious focus

The controls given are CT examinations. The personal risk can only be determined by an experienced doctor after a detailed discussion; the procedure after the period specified in the table must also be discussed individually with the doctor. Smokers are mostly at high risk.

Action

Depending on the risk assessment, further diagnostic examinations such as computed tomography (CT) or magnetic resonance imaging (MRT) and, in special cases, invasive measures such as transthoracic biopsy , thoracotomy or thoracoscopy with the aim of removing tissue for histological examination or, if necessary, complete resection of the focus are to be carried out.

Individual evidence

  1. Philipp Dürkes: The small pulmonary nodule: a diagnostic challenge Dissertation University of Hamburg from March 11, 2008 (PDF; 316 kB)
  2. Frank M. Hasse: Clinic Guide to Surgery. Examination, diagnosis, therapy, emergency. Urban & Fischer, ISBN 978-3-437-22450-8
  3. ^ Fleischner Society Recommendations: Incidental Pulmonary Nodule Follow-up. Radiology, 2005 Nov; 237 (2): 395-400. ( Memento from May 3, 2015 in the Internet Archive )
  4. ^ Heber MacMahon, David P. Naidich, Jin Mo Goo, Kyung Soo Lee, Ann NC Leung: Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017 . In: Radiology . tape 284 , no. 1 , July 2017, ISSN  0033-8419 , p. 228-243 , doi : 10.1148 / radiol.2017161659 .

literature

  • Solitary pulmonary nodules: detection, characterization, and guidance for further diagnostic workup and treatment; PMID 18471382 .
  • Management of SPN in France. Pathways for definitive diagnosis of solitary pulmonary nodule: a multicentre study in 18 French districts; PMID 18402653 .
  • How to deal with incidentally detected pulmonary nodules less than 10mm in size on CT in a healthy person; PMID 18359124 .
  • Lung cancer screening with low-dose computed tomography: A non-invasive diagnostic protocol for baseline lung nodules; PMID 18308420 .
  • Influence of display quality on radiologists' performance in the detection of lung nodules on radiographs; PMID 17709363 .
  • Resection of small indeterminate lung nodules by video-assisted thoracoscopic surgery (VTS). Implications for the early diagnosis of lung cancer; PMID 15852725 .
  • Solitary pulmonary nodule: correlation between radiographic findings and nature of the lesions; PMID 3997472 .