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Solitary Pulmonary Nodule (SPN)/Pulmonary Neoplasms

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Abstract

This chapter opens with how to evaluate the solitary pulmonary nodule, presenting numerous imaging findings that can suggest whether it is benign or malignant. It then describes various benign and malignant pulmonary neoplasms and the three major routes for metastases (hematogenous, lymphangitic, and direct spread).

Keywords

  • Solitary pulmonary nodule
  • Pulmonary granuloma
  • Pulmonary hamartoma
  • Pulmonary arteriovenous malformation
  • Adenocarcinoma of the lung
  • Adenocarcinoma in situ
  • Squamous cell carcinoma of the lung
  • Small cell carcinoma of the lung
  • Large cell carcinoma of the lung
  • Pancoast tumor
  • Hematogenous pulmonary metastases
  • Lymphangitic pulmonary metastases

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References

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Fig. e10.1

Benign hematoma Benign hematoma. Focal, well-circumscribed SPN [1] (TIF 920 kb)

Fig. e10.2

Malignant SPN Malignant SPN. Smoothly marginated, 1 cm peripheral metastasis from bladder cancer, which mimics a benign lesion [1] (TIF 886 kb)

Fig. e10.3

Ossified metastasis Ossified metastasis. Bilateral dense hilar lymph nodes as well as multiple parenchymal metastases [1] (TIF 849 kb)

Fig. e10.4

Ossified metastasis Ossified metastasis. Dense calcification (arrow) within an osteosarcoma metastasis [1] (TIF 1606 kb)

Fig. e10.5

Lung abscess Lung abscess. Large mass in the left lower lobe with thick nodular walls and an air-fluid level (arrow) [2] (TIF 591 kb)

Fig. e10.6

Doubling time of metastasis. (a) Solitary pulmonary nodule (arrow). (TIF 798 kb)

Fig. e10.6

Doubling time of metastasis. (b) Repeat examination 5 months later shows rapid growth of the SPN (white arrow). There now is a second mass (black arrows) that was not appreciated on the previous study because it projected just below the right hemidiaphragm [1] (TIF 793 kb)

Fig. e10.7

Adenocarcinoma in situ Adenocarcinoma in situ. Mixed-attenuation mass, mostly ground-glass, in the left upper lobe (arrow). Note the air bronchograms coursing through the lesion and the pleural tag (TIF 1136 kb)

Fig. e10.8

PET/CT of pulmonary nodules. (a) Spiculated lung cancer in the right upper lobe that is highly FDG-avid (SUVmax 8.9). (b) Lobulated benign nodule in the left lung that has no FDG uptake (SUVmax 1.1). (c) Infection that is highly FDG-avid and mimics a malignancy (SUVmax 9.5) (TIF 1477 kb)

Fig. e10.8

PET/CT of pulmonary nodules. (d) After antibiotic therapy, a follow-up CT 1 month later shows that the lung abnormality has cleared. (Courtesy of J. Anthony Parker, MD/PhD, Boston) (TIF 114 kb)

Fig. e10.9

Mimics of solitary pulmonary nodule Solitary pulmonary nodule. (a) Calcified costal cartilage (arrow). (TIF 158 kb)

Fig. e10.9

Mimics of solitary pulmonary nodule Solitary pulmonary nodule. (b) Blood vessel on end (arrow). (TIF 867 kb)

Fig. e10.9

Mimics of solitary pulmonary nodule Solitary pulmonary nodule. (c) Diffuse soft-tissue masses in neurofibromatosis. (TIF 230 kb)

Fig. e10.9

Mimics of solitary pulmonary nodule Solitary pulmonary nodule. (d) Right clavicle fracture with the tip of the inferomedial fragment (arrow) overlying the right upper chest and simulating a discrete parenchymal nodule (TIF 757 kb)

Fig. e10.10

Tuberculoma Tuberculoma. Benign SPN (arrows) with dense central calcification [1] (TIF 587 kb)

Fig. e10.11

Hamartoma Hamartoma. (a) Typical popcorn calcifications. (TIF 2425 kb)

Fig. e10.11

Hamartoma Hamartoma. (b) Sharply marginated SPN containing small focal areas of fat [1] (TIF 1639 kb)

Fig. e10.12

Pulmonary arteriovenous fistula Pulmonary arteriovenous fistula. (a) Elliptical soft-tissue mass (straight arrows) with feeding and draining vessels (black arrows) extending to the lesion. (TIF 777 kb)

Fig. e10.12

Pulmonary arteriovenous fistula Pulmonary arteriovenous fistula. (b) Arteriogram clearly shows the feeding artery and draining veins (white arrows) associated with the arteriovenous malformation (open arrow) [1] (TIF 761 kb)

Fig. e10.13

Rheumatoid necrobiotic nodules Rheumatoid necrobiotic nodules. Multiple, well-circumscribed rounded nodules of varying size in a patient with subcutaneous rheumatoid nodules and pneumoconiosis (Caplan’s syndrome) [1] (TIF 609 kb)

Fig. e10.14

ANCA-associated vasculitis ANCA-associated vasculitis. CT shows multiple irregular nodules with halo sign (indicating hemorrhage) in a peribronchovascular distribution [1] (TIF 1554 kb)

Fig. e10.15

Adenocarcinoma as solitary pulmonary nodule. Lobulated and spiculated nodule in the right lower lobe [1] (TIF 1962 kb)

Fig. e10.16

Adenocarcinoma in situ. Spiculated, thick-walled cavitary mass with soft-tissue bands extending to the pleural surface (TIF 560 kb)

Fig. e10.17

Adenocarcinoma in situ Adenocarcinoma in situ. Multiple thin-walled cystic lesions [1] (TIF 813 kb)

Fig. e10.18

Adenocarcinoma in situ. Ground-glass lesions bilaterally (arrows). The larger mass in the left lower lobe (large arrow) also contains solid elements. (Courtesy of Diana Litmanovich, MD, Boston) (TIF 689 kb)

Fig. e10.19

Adenocarcinoma in situ. Multiple cavitating ground-glass nodules bilaterally (TIF 590 kb)

Fig. e10.20

Adenocarcinoma in situ. (a) Dominant spiculated mass in the left upper lobe. Note the faint ground-glass lesions just posteriorly (arrow). (TIF 657 kb)

Fig. e10.20

Adenocarcinoma in situ. (b) Second dominant spiculated mass in the right lower lobe (arrow) (TIF 706 kb)

Fig. e10.21

Adenocarcinoma in situ. Multiple poorly defined nodules scattered throughout both lungs mimicking hematogenous metastases [1] (TIF 815 kb)

Fig. e10.22

Adenocarcinoma in situ. Widespread air-space filling with geographic margination. Note the presence of air bronchograms [1] (TIF 842 kb)

Fig. e10.23

Adenocarcinoma in situ Adenocarcinoma in situ. Crazy-paving pattern bilaterally with centrilobular nodules [1] (TIF 1208 kb)

Fig. e10.24

Squamous cell carcinoma. (a) Huge cavitating lesion with thick, irregular walls (arrows) (TIF 1660 kb)

Fig. e10.24

Squamous cell carcinoma. (b) Huge cavitating lesion with thick, irregular walls (arrows) (TIF 708 kb)

Fig. e10.25

Small cell carcinoma. Central left hilar lymphadenopathy (open arrow) with associated enlargement of anterior mediastinal lymph nodes (closed arrows) [1] (TIF 949 kb)

Fig. e10.26

Small cell carcinoma Small cell carcinoma. (a) Large nodal mass along the left superior mediastinum (arrows) (TIF 1557 kb)

Fig. e10.26

Small cell carcinoma Small cell carcinoma. (b) Large nodal mass along the left superior mediastinum (arrows) (TIF 1760 kb)

Fig. e10.26

Small cell carcinoma Small cell carcinoma. (c) Large nodal mass along the left superior mediastinum (arrows) (TIF 616 kb)

Fig. e10.27

Carcinoid tumor Carcinoid tumor. (a) Well-defined, homogeneous round mass in the right upper lobe [1] (TIF 1747 kb)

Fig. e10.27

Carcinoid tumor Carcinoid tumor. (b) Well-defined, homogeneous round mass in the right upper lobe [1] (TIF 977 kb)

Fig. e10.28

Carcinoid tumor. Large mass containing punctate calcifications (arrowhead) and low-attenuation areas related to necrosis. Note the right paratracheal adenopathy [1] (TIF 1290 kb)

Fig. e10.29

Hematogenous metastases Hematogenous metastases. Bilateral masses with air-fluid levels (arrows) from a squamous cell carcinoma of the head and neck [1] (TIF 715 kb)

Fig. e10.30

Hematogenous metastases Hematogenous metastases. Multiple nodules of different size involve both lungs [1] (TIF 529 kb)

Fig. e10.31

Hematogenous metastases. Several cavitating nodules with irregular wall thickening (arrows) in both lower lobes in a patient with squamous cell cancer of the lungs [1] (TIF 1321 kb)

Fig. e10.32

Hematogenous metastases. Diffuse, bilateral, ill-defined opacities with cavitation [3] (TIF 1437 kb)

Fig. e10.33

Lymphangitic metastases Lymphangitic metastases (breast carcinoma). (a) Marked prominence of reticular markings with especially prominent septal lines (TIF 1545 kb)

Fig. e10.33

Lymphangitic metastases Lymphangitic metastases (breast carcinoma). (b) Marked prominence of reticular markings with especially prominent septal lines (TIF 589 kb)

Fig. e10.34

Lymphangitic metastases. Extensive abnormalities with thickening of the interlobular septa (straight arrows), major fissures, and bronchovascular bundles (curved arrow) [1] (TIF 1179 kb)

Fig. e10.35

Lymphangitic metastases. Diffuse prominence of coarse interstitial markings bilaterally (TIF 645 kb)

Fig. e10.36

Lymphangitic and hematogenous metastases. (a) Left hilar mass causes severe bronchial narrowing. Note the thickening of interstitial structures at the margins of the secondary lobules. The posterior, dependent lung and opposite side are not involved, indicating that this represents lymphangitic spread rather than dependent edema. (TIF 572 kb)

Fig. e10.36

Lymphangitic and hematogenous metastases. (b) Post-obstructive atelectasis distal to the hilar neoplasm. (TIF 652 kb)

Fig. e10.36

Lymphangitic and hematogenous metastases. (c) Laterally, there is a well-defined opacification representing a hematogenous metastasis (arrow). Note the presence of an ipsilateral pleural effusion, which makes this a non-resectable tumor (TIF 602 kb)

Fig. e10.37

Lymphoma Lymphoma. Multiple pulmonary nodules on a study obtained 10 months after cardiac transplantation [1] (TIF 657 kb)

Fig. e10.38

Calcified lymphoma Calcified lymphoma after radiotherapy and chemotherapy. (a) Combination of post-therapy fibrosis and calcification in the region of a previous anterior mediastinal mass (TIF 1768 kb)

Fig. e10.38

Calcified lymphoma Calcified lymphoma after radiotherapy and chemotherapy. (b) Combination of post-therapy fibrosis and calcification in the region of a previous anterior mediastinal mass (TIF 829 kb)

Fig. e10.39

Kaposi’s sarcoma Kaposi’s sarcoma. Two irregular flame-shaped nodules (white arrows) in the apex of the right lung [5] (TIF 720 kb)

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Eisenberg, R.L. (2020). Solitary Pulmonary Nodule (SPN)/Pulmonary Neoplasms. In: What Radiology Residents Need to Know: Chest Radiology . Springer, Cham. https://doi.org/10.1007/978-3-030-16826-1_10

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  • DOI: https://doi.org/10.1007/978-3-030-16826-1_10

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