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Chest X-Ray
 
 

Pulmonary Nodules and Masses

 
 
 
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Overview

Pulmonary nodules are commonly seen on chest x-rays, and solitary nodules are often benign.
  • Look For

  • Number of nodules
  • Size of nodules
  • Border - smooth or irregular
  • Density - solid or ground glass
  • Speed of progression
  • Causes of Pulmonary Nodule

  • Benign

  • Granuloma
  • Hamartoma
  • Infection - abscess, organising pneumonia, fungal infection, tuberculosis, septic emboli
  • Inflammation - sarcoidosis, rheumatoid lung disease, granulomatosis with polyangiitis
  • Vascular - pulmonary infarction
  • Malignant

  • Primary lung cancer
  • Metastasis
  • Lymphoma
  • Interpretation

  • Solidary pulmonary nodule - more likely to represent a granuloma, however may be due to lung cancer or abscess
  • Multiple pulmonary nodules - suggestive of metastases, tuberculosis, septic emboli or inflammatory disease
  • Small (<5mm) nodule - more likely to be benign
  • Smooth border - more likely to be benign
  • Irregular or spiculated border - more likely to be malignant
  • Solid nodule - more likely to be benign
  • Ground glass appearance - more likely to be malignant
  • Rapidly enlarging nodule - more likely to be malignant 
  • Examples

  • A granuloma in the right lower zone
  • A granuloma in the right lower zone
     
  • A right hilar mass
  • A right hilar mass
     

Cavitating Lung Lesions

  • Look For

  • A gas-filled cavity within a nodule or area of consolidation.
  • Causes of Cavitating Lesions

  • Infection - necrotising pneumonia, lung abscess, tuberculosis, non-tuberculous mycobacteria, aspergillosis, septic emboli
  • Inflammation - granulomatosis with polyangiitis, rheumatoid nodule
  • Neoplasia - primary lung cancer, metastasis
  • Example

  • Cavitating lung disease of the upper lobes in a patient with tuberculosis
  • Cavitating lung disease of the upper lobes in a patient with tuberculosis
     
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