Nodules – Diagnostic Imaging

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.