Diagnostic Radiology/Chest Imaging/Pulmonary Nodules


 * 1) State the definition of a solitary pulmonary nodule and a pulmonary mass
 * 2) Name the three most common causes of a solitary pulmonary nodule
 * 3) Name four important considerations in the evaluation of a solitary pulmonary nodule
 * 4) Name six causes of cavitary pulmonary nodules
 * 5) Name four causes of multiple pulmonary nodules
 * 6) State the indications for percutaneous biopsy of a solitary pulmonary nodule
 * 7) State the indications for percutaneous biopsy when there are multiple pulmonary nodules
 * 8) State the complications and the frequency with which complications occur due to percutaneous lung biopsy using CT or fluoroscopic guidance
 * 9) State the indications for chest tube placement as a treatment for pneumothorax related to percutaneous lung biopsy
 * 10) State the role of positron emission tomography (PET) in the evaluation of a solitary pulmonary nodule

Work up of new or enlarged solitary pulmonary nodule (SPN) in Chest X-ray or SPN on CT
Perform a High Resolution CT-scan (HRCT) study


 * Benign calcification or shape: No further work-up is indicated.
 * Fat (with or without calcification) : No further work-up is indicated.
 * Indeterminate:
 * 4–10 mm: Follow up with CT volumetrics studies in 6, 12, and 24 months.
 * >10 mm:
 * ground glass opacity with or without a solid lesion: biopsy/resect
 * solid: CT with IV contrast, PET, or Biopsy
 * In contrast CT, malignant lesions show an increase of greater than 15H after contrast (98% sensitive for 6-30 mm nodules)
 * PET with Fluorine-18-labeled fleurodeoxyglucose is 97% sensitive, and 78% specific for nodules that are larger than 10 mm
 * if negative: follow up in 6, 12, and 24 months

Doubling time (volume) of less than one month or longer than two years suggest a benign lesion.