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.