coin lesion
DESCRIPTION
Target: UG medical students.TRANSCRIPT
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