Dr.CSBR.Prasad, M.D.

Coin Lesion

CSBRP-Dec-2012

Coin Lesion

Def: Any of various solitary, round, circumscribed shadows appearing in radiographic examinations of the lungs that are believed to be caused by tuberculosis, carcinoma, cysts, infarcts, or vascular anomalies.

CSBRP-Dec-2012

CSBRP-Dec-2012

Coin Lesion

CSBRP-Dec-2012

Risk of malignancy increases with the age

Patients who are >50yrs, the probability of

SPN to be malignant is 50%

CSBRP-Dec-2012

Solitary Pulmonary Nodule

Common causes:

• Primary lung cancers

• Metastases

• Infections: TB, Pneumonia

• Pseudotumor

Less common causes:

• Lymphoma

• Mesothelioma

• Carcinoid

• Chondroma

• Hamartoma

• Cysts – Hydatid

• Rheumatoid nodule

• Pulmonary sequestration

• Pulmonary infarct

• AV malformation

CSBRP-Dec-2012

Solitary Pulmonary Nodule

• SPN requires prompt and accurate Dx

• A nodule that has not changed in size for two

years is nearly always benign

• Rapidly enlarging nodule suggests either

infection or inflammation

• CT scans are helpful in DD behaviour

• SPN requires histological confirmation

• If CT / biopsy fail to confirm the nature of the

SPN, surgical excision should be considered

CSBRP-Dec-2012

Solitary Pulmonary Nodule

Clinical features:

Majority are clinically silent

Cough

Cervical lymphadenopathy

Finger clubbing

Source of mets – Abdomen/Breast/Testis

Rash – Vasculitis

CSBRP-Dec-2012

Chest X-ray

Must be evaluated carefully:

Presence of emphysema suggests a significant

smoking history

An upper lobe location would suggest a TB

Presence of heart failure in a patient with a SPN at

the horizontal fissure suggests a pseudotumor

Calcification indicates benign lesion

Malignant lesions have shaggy, spiculated or

lobulated margin

CSBRP-Dec-2012

Solitary Pulmonary Nodule

Rule-1

A nodule that has not changed in size for

two years is nearly always benign

CSBRP-Dec-2012

Solitary Pulmonary Nodule

Rule-2

Rapidly enlarging nodule would suggest either infection or inflammation

Fast growing tumors are uncommon

CSBRP-Dec-2012

Solitary Pulmonary Nodule

Rule-3

A nodule in a patient with a h/o smoking

should be considered malignant until

proven otherwise

CSBRP-Dec-2012

Solitary Pulmonary Nodule

Rule-4

Calcification suggests a benign lesion

Patterns of calcification:

A central nidus suggests granuloma

Lamination suggests granuloma – histoplasma

Pop-corn pattern suggests Hamartoma

Multiple punctate pattern – Hamartoma / Granuloma CSBRP-Dec-2012

CSBRP-Dec-2012

Encysted effusion CSBRP-Dec-2012

Encysted effusion CSBRP-Dec-2012

E N D

CSBRP-Dec-2012