Nodules – Diagnostic Imaging

by Carlo Raj, MD

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    00:01 What I like to point out here, this is a CT scan.

    00:05 There are two of them here. And interesting enough, the one on your left, CT, letter A, on the right side of the lung.

    00:16 In those arrow that is then pointing to a nodule. Okay. Now look at that nodule B.

    00:22 What would that nodule here could be, maybe perhaps metastasis if you find many, many, many, many nodules.

    00:27 Maybe it's particular nodule if you're thinking about your interstitial type of lung disease such as fibrosis.

    00:34 The one picture on the CT, on the right, letter B then represents a huge nodule in the right lung.

    00:43 That huge nodule here – maybe this was a patient.

    00:46 Let me give this patient to you. There is a coughing up of blood and this blood is rather foamy.

    00:53 So now you know that the blood is of origin from the lung and there's also hematuria.

    00:58 In addition, you find that the patient has fevers. Either way, chest CT and you find a huge nodule such as this, maybe thinking along the lines of granulomatosis with polyangiitis.

    01:10 Or you find a nodule like this and it's in the setting of a patient that has night sweats, fever and weight loss.

    01:17 In addition, the patient comes back and tends to be positive for acid-fast type of stain.

    01:24 Maybe you're thinking about a granuloma but that would be [inaudible 01:27]. Are we clear? So when we say nodule, it's rather opaque or may be perhaps that nodule that you see there is a patient that had a history of smoking.

    01:37 And with smoking, also I'll give you a few other type of symptoms here.

    01:43 Where the patient feels a little constipated, maybe a little stupor and you find the calcium levels to be quite high.

    01:49 And then on chest CT, you end up finding a huge nodule such as this. What's your diagnosis? With smoking and you're thinking cancer.

    01:58 I'll give you two major lung cancers associated with smoking. What are they? Small. Good.

    02:04 And the other one was squamous.

    02:07 How can you differentiate between the two? I'll give you a little more didn't I? I gave you symptoms of headache and stupor. And I gave you constipation.

    02:15 And I gave you increased calcium. Now you tell me which lung cancer this is.

    02:19 Very good. Squamous cell lung cancer. Paraneoplastic increase in PTHrP.

    02:25 Okay. Associated with smoking? Sure. And the nodule here is what you're seeing.

    02:30 So as you can see with nodules, it becomes quite important for you to then identify any parenchyma and it gives you a list of differentials.

    02:37 But understand please, you're always, always going back to the history of your patient.

    About the Lecture

    The lecture Nodules – Diagnostic Imaging by Carlo Raj, MD is from the course Pulmonary Diagnostics.

    Included Quiz Questions

    1. Granulomatosis with polyangiitis
    2. Atypical pneumonia
    3. Tuberculosis
    4. Hypersensitivity pneumonitis
    5. CHF
    1. Squamous cell carcinoma of the lung
    2. Small cell carcinoma of the lung
    3. Adenocarcinoma of the lung
    4. Oat cell carcinoma of the lung
    5. Large cell carcinoma of the lung

    Author of lecture Nodules – Diagnostic Imaging

     Carlo Raj, MD

    Carlo Raj, MD

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