Category |
Description |
Benign Causes |
- Granulomas: Most commonly infections e.g. TB or histoplasmosis. Often calcified.
- Hamartomas: Benign tumours that typically contain cartilage, fat, and connective tissue. Most common benign tumours of the lung.
- Infectious Nodules: Bacteria, fungi, or parasites. History of recent or past infections.
- Inflammatory Nodules: Conditions like RA/Wegener's granulomatosis, causing localized inflammation in the lungs.
- Vascular Lesions: AVM or pulmonary infarcts, which may appear as nodules.
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Malignant Causes |
- Primary Lung Cancer: The most concerning cause of an SPN, especially in older smoker. Adenocarcinoma is commonest.
- Metastatic Tumours: Secondary cancer from breast, colon, or kidney.
- Carcinoid Tumours: Neuroendocrine tumours can appear as solitary nodules and malignant.
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Management |
Initial Evaluation |
- Review of Imaging: Evaluate prior chest imaging to assess the stability of the nodule over time. Static Nodules for 2 years are likely benign.
- Risk Assessment: Consider age, smoking history, size, and characteristics of the nodule (e.g., size, shape, calcification).
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Low-Risk Nodules |
- Serial Imaging: CT scans at intervals (e.g., 3, 6, 12, and 24 months) to monitor for changes in size or appearance.
- Observation: Many benign nodules can be safely monitored without invasive procedures if they remain stable over time.
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Intermediate-Risk Nodules |
- Further Imaging: PET-CT scan to assess metabolic activity. Highly active nodules may warrant biopsy.
- Biopsy: Consider transthoracic needle biopsy or bronchoscopy, depending on the anatomy and access and size.
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High-Risk Nodules |
- Surgical Resection: If a nodule is highly suspicious for malignancy, especially in high-risk patients, surgical removal (lobectomy, segmentectomy) is often recommended.
- Video-Assisted Thoracoscopic Surgery (VATS): A minimally invasive surgical option to obtain a biopsy or remove the nodule.
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Post-Treatment Follow-Up |
- Ongoing Surveillance: Regular follow-up imaging to monitor for recurrence or the development of new nodules, particularly in patients with a history of malignancy.
- Oncologic Consultation: For malignant nodules, multidisciplinary management including oncology, pulmonology, and thoracic surgery may be necessary.
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