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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