Solitary Pulmonary Nodule - MedPix® Medical Image Database and Teaching Files

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Disease Topic 2734
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Contributor: James G. Smirniotopoulos, M.D. - Uniformed Services University

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Solitary Pulmonary Nodule
Factoid 2734 - Created: 2001-09-01 23:25:47-04 - Modified: 2007-06-02 06:09:58-04

ACR Codes: 6.3
A Solitary Pulmonary Nodule (SPN) MUST be evaluated. SPN's are seen in about 2/1000 chest films. Small (<1.0 cm) nodules - especially in young patients, and are most commonly benign (e.g. hamartoma). However, since an SPN may be cancer, and survival in Ca is improved with early resection (5yr for a 1cm is 80% but for 3cm nodule drops to 50%).

Evaluation methods include:
• high-resolution CT (looking for calcium, margins, etc)
• serial followup studies
• retrospective review (look at older images)
• biopsy or resection

If watchful waiting is used, most benign processes do NOT grow, or grow very slowly. Acute inflammatory process may grow very rapidly. One reasonable follow up schedule:
• 4 weeks
• 6 weeks
• 3 months
• 4-6 months up to 2 years

Followup imaging in 4 weeks, DOUBLE tumor volume increases DIAMETER by only 28%
Doubling Time < 20 days is usually inflammatory
Most tumors double in 25 - 450 days with a median for Lung CA of 120 days. Any growth may prompt biopsy and/or resection.

References: http://www.postgradmed.com/issues/1997/03_97/lilling.htm

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SPN - Risk Calculations:
http://www.chestx-ray.com/SPN/SPNProb.html

http://www.emedicine.com/radio/topic782.htm

Reference(s):
http://www.postgradmed.com/issues/1997/03_97/lilling.htm

http://www.chestjournal.org/cgi/content/full/116/suppl_3/523S

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Location: Chest, Pulmonary (ex. Heart)	Sublocation: Pulmonary (lung)	Category: Clinical Exam Finding or Sign
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Prepared by: James G. Smirniotopoulos, M.D.
Affiliation: Uniformed Services University - || -
Approved by: David S. Feigin, M.D.
Affiliation: Johns Hopkins Hospitals - || -

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