Pages

Sunday, July 30, 2017

Solitary Pulmonary Nodule



Definition: a single, <3 cm discrete, well-marginated, rounded opacity, surrounded by normal lung, with no lymphadenopathy or pleural effusion.
It is often an incidental finding, especially with increased use of CT scan but still it could be an be early, curable malignancy.

Etiology:
1. Benign (70%): Granuloma, Hemartoma, Bronchogenic cyst, AV malformation, Rheumatoid nodule
2. Malignant (39%): Bronchogenic carcinoma, Metastases from breast, heard, neck , colon.

Initial evaluation
• History: h/o cancer, smoking, age (<30 years = 2% malignant)
• CT: size/shape, calcium deposits, Lymphadenopathy, effusions, bony destruction, compare with old studies.

• High-risk features for malignancy: 

  • ≥2.3 cm diameter, 
  • spiculated,
  •  >60 years old, 
  • >1 ppd current smoker, 
  • no prior smoking cessation
Diagnostic studies


1. Positron-Emission Tomography (PET)
Whether positron-emission tomography (PET) scanning will be useful in a patient’s workup depends on 
(1) the clinical pretest probability of malignancy, 
(2) nodule morphology, 
(3) the size and position of the nodule, and 
(4) the scanning facility available
It detects metabolic. activity of tumors, also useful for surgical staging as it may detect unsuspected metastases, and useful in deciding which lesions to biopsy vs. follow with serial CT.

2. Transthoracic needle biopsy (TTNB): if technically. feasible, 97% will obtain definitive tissue for diagnosis.

3. Video-assisted thoracoscopic surgery (VATS): for percutaneously inaccessible lesions; highly sensitive and allows resection; has replaced thoracotomy.

4. Biopsy: A biopsy of a lung nodule should be performed to determine whether it is malignant.  Biopsy of a solitary pulmonary nodule can be performed bronchoscopically or via CT-guided transthoracic needle aspiration (TTNA).

Management (for solid Solitary Pulmonary Nodule >8 mm; .... if ≤8 mm, serial CT) 
• Low risk (<5%): serial CT (freq depending on risk); shared decision with patient and refer for biopsy
• Intermediate risk (5–60%): PET, if negative → follow low-risk protocol; if positive → high-risk protocol
• High risk (and surgical candidate): TBB, TTNB, or VATS → lobectomy if malignant
• Ground-glass nodules: longer follow up because even if malignant can be slow-growing and PET negative.

5 comments:

  1. I really appreciate  DR AKHIGBE,my name is LAURIE HUGHES . I will never stop testifying DR AKHIGBE , Happiness is all i see now I never thought that I will be cured from HIV virus again. DR AKHIGBE did it for me I have been suffering from a deadly disease (HIV) for the past 2 years now, I had spent a lot of money going from one place to another, from churches to churches, hospitals have been my home every day residence. Constant checks up have been my hobby not until this faithful day,  I saw a testimony on how DR AKHIGBE helped someone in curing his HIV disease in internet quickly I copied his email which is drrealakhigbe@gmail.com just to give him a test I spoke to him, he asked me to do some certain things which I did, he told me that he is going to provide the herbal cure to me, which he did, then he asked me to go for medical checkup after some days, after using the herbal cure and i did, behold I was free from the deadly disease,till now no HIV in me again he only asked me to post the testimony through the whole world, faithfully am doing it now,all the testimony of DR AKHIGBE is true  please BROTHER and SISTER, MOTHER and FATHER he is great, I owe him in return. if you are having a similar problem just email him on drrealakhigbe@gmail.com or you can whats App his mobile number on +2348142454860  He can also cure these diseases like HIV and AIDS HERPES,DIABETICS,CANCER, HEPATITIS A&B,CHRONIC DISEASES, ASTHMA, HEART DISEASES, EXTERNAL INFECTION, EPILEPSY, STROKE, MULTIPLE SCLEROSIS, NAUSEA,VOMITING OR DIARRHEA,PARKINSON DISEASE,INFLUENZA,. COMMON COLD, AUTOIMMUNE DISORDER, LUPUS,ECZEMA,BACK PAIN, JOINT SCHIZOPHRENIA , PAIN.LOWER RESPIRATORY INFECTION. .ETC .please email drrealakhigbe@gmail.com    or whats APP him  ..+2348142454860  he is a real good and honest man.  
    website...  https:drrealakhigbe.weebly.com

    ReplyDelete
  2. For years, I have read and seen the advertisements in the mass media about all of the penis enhancement pills and thought that they were all scams or gimmicks. All of the medical sites that I have visited stated that none of the herbal supplements would ever help increase the size of a penis. I got very depressed when I read this, because unfortunately I was not naturally blessed with a penis that was big enough to arouse my sexual partner or past partners. I am a man that is past my sexual primetime and my sexual performance has a lot to be desired. I decided to try Doctoc Akhigbe herbal medicine after all the reading and researching that I have done.I saw a testimony " Joe" about doctror Akhigbe Herbal Medicine Since there is a Money Back Guarantee, I give him a trial what did I have to lose? I couldn't believe the results I was seeing after drinking the Natural  Herbal Medicine  and Herbal Soap to be rubign my penis! he sent to me through DHL courier delivery service . Within about 2 weeks I had a noticeable increase in the girth of my penis. Then after a coupleof aditional week it started to grow in length and I was amazed and very excited.before I finish the drink and the soap my penis had grown an additional two inches. I've had a considerable improvement with my sex life and these pills are certainly worth every penny I spent on them! I want to thank Dr Akhigbe for the time and effort they have spent on helping people in my situation.I know many are out there who are suffering this problem and they need help, email him.    drrealakhigbe@gmail.com.    He also cure other diseases like: . HIV/ AIDS. JOINT PAIN, BREAST ENLARGEMENT. DIABETIES.  HERPES. AUTISM . NO PRIOD.  CHRONIC DISEASES. LUPUS . MALE AND FEMALE FERTILITY. WAST & BACK PAIN. CANCER . DISCHARGE FROM BREAST PAIN, BREAST INFECTION. PARKINSON DISEASES.  WOMEN SEXUAL PROBLEM.  VAGINAL INFECTION. IRREGULAR MENSTRATION , PAIN & ITCHING, TOXOPLASMOSIS,  . LOWER ABDOMINAL PAIN PAIN DURING SEX INSIDE THE PELVIC . PREMATURE EJACULATION.  PAIN DURING URINATION. PELVIC INFLAMATORY DISEASES , VAGINAL DISCHARGE. (PID). PULMONARY FIBROSIS, DRIPPING OF SPERM FROM THE VAGINAL AS WELL AS FOR LOW SPERM COUNT. DENGUE, TUBERCULOSIS. CIRRHOSIS .    ITCHING OF THE PRIVATE PART. ZERO SPERM COUNT.  ASTHMA.  . ,  EJACULATION. WEAK ERECTION. ERYSIPELAS, DISCHARGE FROM PENIS . HPV. QUICK EJACULATION. HEPATITIS A & B. STD. STAPHYLOCOCCUS + GONORRHEA + SYPHILIS. HEART DISEASE.  PILE-HEMORRHOID. HIGH BLOOD PRESSURE. RHIUMATISM, THYROID, PENIS ENLARGEMENT  .   For your cure email him now:   drrealakhigbe@gmail.com    or Contact his numbe:  +2349010754824.

    ReplyDelete
  3. 2 WEEKS AGO I ENDED NATURAL HERBAL TREATMENT FROM TRADITIONAL HEALER WHO IS IN AFRICAN, I GOT RID OF HPV VIRUS OUT OF MY BODY WITH HIS HERBAL TREATMENT. It SO AMAZING I'M FREE FROM THIS VIRUS FOREVER. YOU CAN REACH HIM ON; DRONOKUNHERBALCURE@GMAIL.COM  

    ReplyDelete

  4. My name is Tracy witchcraft from USA. Am here to testify of a great and powerful spell caster named Dr. Onobun Gabriel(WATER). I was so confused and devastated when my lover left me for another girl. I needed him so back desperately because i loved him so much. So i contactedd this great spell caster on
    onobunwinhome@gmail.com for help. He helped me cast a love spell, return love spell on my boyfriend and just within 24hours time, My boyfriend called me on my Phone saying that his coming back to me, crying and begging me for my forgiveness. Dr. Onobun Gabriel (WATER) released him to really know how much i really do loved and wanted him back peacfully, right now Dr Onobun Gabriel(WATER) also opened his eyes to picture him and how much love we have share together to be real lovers, As I am writing this testimony on the internet right now, i am the most happiest woman on earth. I want to recommend this great spell caster to anyone that truly needs an urgent solutions to a love, break up bring back Ex. Email him at; onobunwinhome@gmail.com or Whatsapp his cell phone number on +2349132393661

    ReplyDelete
  5. I started on COPD Herbal treatment from Ultimate Life Clinic, the treatment worked incredibly for my lungs condition. I used the herbal treatment for almost 4 months, it reversed my COPD. My severe shortness of breath, dry cough, chest tightness gradually disappeared. Reach Ultimate Life Clinic via their website at www.ultimatelifeclinic.com I can breath much better and It feels comfortable!

    ReplyDelete