Lung shadows

Lung shadows ( masses or nodules) Causes of solitary pulmonary shadow ( nodule or mass) Bronchial carcinoma. Benign tumor of the lung e.g hamartoma. Infective granuloma e.g Tuberculoma. Metastasis. Lung abscess.

Nodule in a patient over 40, and a smoker , highly suspected bronchial carcinoma In a patient less than 30 years , primary carcinoma is highly unlikely.

How to differentiate 1- Comparison with previous film Lake of changes over a period of 18 months or more , strong pointer to benign tumor of infective granuloma. An enlarging mass is highly likley of bronchial carcinoma or metastasis.

How to differentiate 2- Calcification Calcification is a common finding in hamartoma (pop corn calcification). tuberculoma Fungul granuloma CT may be needed to detect calcifications.

How to differentiate 3- Involvement of the adjacent chest wall Tumor of the apex is liable to invade the chest wall and adjacent bones ( pancost’s tumor ) .

How to differentiate 4- The shape of the shadow Primary carcinoma always rounded with lobulated, notched, or infiltrating outline.

How to differentiate 5-Cavitation Cavitation is most common with lung abscess, relatively with primary carcinoma and occasionaly with metastasis. Cavitation doesn’t occur with benign hamartoma or inactive tuberculoma.

How to differentiate 6-Size A solitary mass over 4 cm in diameter with no calcification is always primary carcinoma or a lung abscess . Lung abscess of this size usually show cavitation.

How to differentiate 7- Other lesions Metastasis are most common cause of multiple nodules . Pleural effusion is a sign of metastasis.

The role of CT in solitary pulmonary shadow :- A- Diagnose the nature of the nodule. B- Better to detect calcification in a nodule. C- Stage the extent of the disease. D- Localize the nodule before bronchoscopic or percutaneous needle biopsy.

Bronchial carcinoma Two types are detected:- 1- Central tumor 2- Peripheral tumor

Bronchial tumor Presentation:- Cough . Haemoptysis. Shortness of breath. Weight loss.

Radiological signs of central tumor

Radiological signs of central tumor Collapse and consolidation

Radiological signs of peripheral tumor Usually presents as a solitary pulmonary mass . The signs are A rounded shadow with an irregular border. Lobulation, notching and infilterating. Cavitation within the mass, the wall of the cavity is thick and irregular.

Pulmonary Metastasis Radiographic signs:- May be solitary or multiple. Well defined multiple spherical shadows, vary in size . Irregular borders are occasionaly seen.

Pulmonary Metastasis Large (cannonball) lung metastases from renal cell carcinoma.

Tuberculoma Spherical mass , less than 3 cm in diameter . The edge is sharply defined. Partially calcified. CT may be needed to demonstrate the calcifications.

Hamartoma Most common benign lung tumor

Hamartoma Location • 2/3 are peripheral • Endobronchial in 10%             • Rarely multiple 

Hamartoma Clinical • Mostly asymptomatic • Cough             • Fever (with postobstructive pneumonia)            

Hamartoma Radiological Findings • Round, smooth mass vary in size ,up to 10 cm. • popcorn Calcification. • Fat in 50% - detected by CT  

Hamartoma

Hamartoma Presence of fat is a specific diagnostic sign. Endobronchus hamartoma may lead to airway obstruction with post operative pneumonia and collapse. CT may be needed to detect calcification and fat.

Hamartoma

Granuloma May be solitary or multiple ,localized or diffuse. Usually calcified.

Lung abscess Spherical shadow containing a central lucency due to air within the cavity. An air fluid level may be present.

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