Chest Radiology > Interpretation > Signs > Solitary Nodule


Solitary Pulmonary Nodule

A solitary nodule in the lung can be totally innocuous or potentially a fatal lung cancer.  After detection the initial step in analyis is to compare the film with prior films if available.  A nodule that is unchanged for two years is almost certainly benign.  If the nodule is completely calcified or has central or stippled calcium it is benign.  Nodules with irregular calcifications or those that are off center should be considered suspicious, and need to be worked up further with a PET scan or biopsy.  

Be sure to evaluate for the presence of multiple nodules as this finding would change the differential entirely.  If the nodule is indeterminate after considering old films and calcification, subsequent steps in the work-up include ordering a CT and a tissue biopsy.  The patient may choose to have an indeterminate nodule removed if there is no evidence of spread on CT as this would diagnose and treat a cancer if present.

 

This patient clearly has a solitary lung nodule present on chest x-ray.  Can you tell which lobe it's in?  Did you spot the other nodule?  Some early lung cancers are missed on the initial chest x-ray because they are small and faint.  CT may detect these early cancers.

 

PA and Lateral of a subtle right lower lobe cancer.  Can you find it in the frontal projection? 
(Click on the image for the answer)

 

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