Pulmonary nodule differential diagnosis

Jump to: navigation, search
Home logo1.png

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2], Maria Fernanda Villarreal, M.D. [3]

Overview

Pulmonary nodule may be differentiated according to imaging (size, border characteristics, and attenuation), histological, and clinical features, from other diseases that demonstrate similar imaging findings. Common differential diagnoses of pulmonary nodule include hamartoma, granulomas, rheumatoid nodule, and metastatic lesions.

Differentiating Pulmonary Nodule from Other Diseases

  • The table below summarizes the findings that differentiate pulmonary nodule from other conditions that cause similar radiological findings on CT scan of the chest.[1][2]
ABBREVIATIONS:N/A: Not available , SOB: Shortness of breath, M/C: Most common
Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical exam
Lab Findings CT scan Histopathology
Productive cough Hemoptysis Weight loss SOB Fever Other Auscultation Sputum analysis Nodule Nodule content Other findings
Pulmonary Nodule(benign)

[3]

- - - - -
  • N/A
  • Normal
  • Normal
Fat

Calcification

Types:

  • Central dense nidus
  • Diffuse solid
  • Laminated
  • Popcorn
  • N/A
  • N/A
Pulmonary Nodule (malignant)

[3][4]

++ ++ ++ + -
  • Normal
  • Single or multiple
  • Small or > 2 cm of size
Calcification

Cavity

Ulceration

  • Spiculated border
  • Rapid growth rate (Doubling time 1-18 months)
  • Cavity wall thickness over 15 mm
Diseases Productive cough Hemoptysis Weight loss SOB Fever Other Auscultation Sputum analysis Nodule Content Other findings Histopathology Gold standard Additional findings
Abscess

[5]

++ - - + ++
  • Vary in size
  • Round in shape
.
Septic pulmonary

emboli

[6]

- - - ++ ++
  • N/A
  • Multiple peripheral nodules
  • Size 0.5 - 3.5 cm
  • Variable shapes
  • N/A
  • N/A
Fungal

infection

[7]

+/- + - + +
  • N/A
Parasites

[8]

+/- +/- +/- _ +
  • N/A
Cyst:

Coin lesion:

  • N/A
Diseases Productive cough Hemoptysis Weight loss SOB Fever Other Auscultation Sputum analysis Nodule Content Other findings Histopathology Gold standard Additional findings
Mycobacterial infections

[9][10]

+ + + ++ +/-
  • AFB+
  • Micronodules in the subpleural region and peribronchovascular interstitium
  • Fluffy upper zone shadowing
  • Cavity
  • N/A
Chronic inflammatory conditions

(Granulomatosis with polyangiitis)

[11]

+/- + - + -
  • N/A
  • Multiple round lesions
  • Size 0.5 - 10 cm
Diseases Productive cough Hemoptysis Weight loss SOB Fever Other Auscultation Sputum analysis Nodule Content Other findings Histopathology Gold standard Additional findings
Pulmonary AVMs

[12]

- +/- - + -
  • Solitary or multiple nodules
  • Round, oval, or polycyclic
  • Size 1 - 5 cm
  • Not done
  • N/A
Pneumoconiosis + - + + -
  • Solitary or multiple nodules
  • Size 1 - 10 cm
  • In the upper lobes
  • N/A
  • N/A
ABBREVIATIONS:N/A: Not available , SOB: Shortness of breath, M/C: Most common

References

  1. Ost D, Fein AM, Feinsilver SH (2003). "Clinical practice. The solitary pulmonary nodule". N. Engl. J. Med. 348 (25): 2535–42. doi:10.1056/NEJMcp012290. PMID 12815140. Unknown parameter |month= ignored (help)
  2. McWilliams A, Tammemagi MC, Mayo JR, et. al. Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med. 2013 Sep 5;369(10):910-9. doi:10.1056/NEJMoa1214726.
  3. 3.0 3.1 Khan AN, Al-Jahdali HH, Irion KL, Arabi M, Koteyar SS (October 2011). "Solitary pulmonary nodule: A diagnostic algorithm in the light of current imaging technique". Avicenna J Med. 1 (2): 39–51. doi:10.4103/2231-0770.90915. PMC 3507065. PMID 23210008.
  4. Li J, Xia T, Yang X, Dong X, Liang J, Zhong N, Guan Y (April 2018). "Malignant solitary pulmonary nodules: assessment of mass growth rate and doubling time at follow-up CT". J Thorac Dis. 10 (Suppl 7): S797–S806. doi:10.21037/jtd.2018.04.25. PMC 5945695. PMID 29780626.
  5. Kuhajda I, Zarogoulidis K, Tsirgogianni K, Tsavlis D, Kioumis I, Kosmidis C, Tsakiridis K, Mpakas A, Zarogoulidis P, Zissimopoulos A, Baloukas D, Kuhajda D (August 2015). "Lung abscess-etiology, diagnostic and treatment options". Ann Transl Med. 3 (13): 183. doi:10.3978/j.issn.2305-5839.2015.07.08. PMC 4543327. PMID 26366400.
  6. Chang E, Lee KH, Yang KY, Lee YC, Perng RP (2009). "Septic pulmonary embolism associated with a peri-proctal abscess in an immunocompetent host". BMJ Case Rep. 2009. doi:10.1136/bcr.07.2008.0592. PMC 3029652. PMID 21686732.
  7. Chong, Semin; Lee, Kyung Soo; Yi, Chin A; Chung, Myung Jin; Kim, Tae Sung; Han, Joungho (2006). "Pulmonary fungal infection: Imaging findings in immunocompetent and immunocompromised patients". European Journal of Radiology. 59 (3): 371–383. doi:10.1016/j.ejrad.2006.04.017. ISSN 0720-048X.
  8. Kunst H, Mack D, Kon OM, Banerjee AK, Chiodini P, Grant A (June 2011). "Parasitic infections of the lung: a guide for the respiratory physician". Thorax. 66 (6): 528–36. doi:10.1136/thx.2009.132217. PMID 20880867.
  9. Ryu YJ (April 2015). "Diagnosis of pulmonary tuberculosis: recent advances and diagnostic algorithms". Tuberc Respir Dis (Seoul). 78 (2): 64–71. doi:10.4046/trd.2015.78.2.64. PMC 4388902. PMID 25861338.
  10. Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
  11. Kubaisi B, Abu Samra K, Foster CS (May 2016). "Granulomatosis with polyangiitis (Wegener's disease): An updated review of ocular disease manifestations". Intractable Rare Dis Res. 5 (2): 61–9. doi:10.5582/irdr.2016.01014. PMC 4869584. PMID 27195187.
  12. Khurshid I, Downie GH (April 2002). "Pulmonary arteriovenous malformation". Postgrad Med J. 78 (918): 191–7. PMC 1742331. PMID 11930021.

Linked-in.jpg