Consultation and analysis (2022.9.6): What is the most important and important thing to pay attention to to determine the benign and malignant nature of lung nodules?

Basic information:

Male 59 years old

Complaints:

Physical examination found that the upper right lung nodule was nearly July

Current medical history:

Imaging examination: In February 2022, he was admitted to the central hospital due to stomach pain, and when he did CT examination, he found that there was a nodule on the right lung, and the size was 6X7mm; On April 2, go to the hospital for re-examination CT report indicating that the nodule size is the same as before; And on April 13, to a famous domestic hospital petCT examination report prompts the possibility of benign; On 23 August, a reinforced thin CT of the lung was reviewed, and the report showed that the nodule size was the same as before

Treatment: In May, I treated lung nodules with a 16-day drug (swollen arthropod tablets

Smoking history: more than 30 years of smoking history

Helpful Wanted:

To confirm whether the nodules are benign and whether surgery

Image display and analysis:

Let's first look at three lesions of the right middle lobe with a 5 mm layer thick at different times:

In February 2022, it was shown that the lung boundary of the right middle lobe tumor was clear, the ground glass density nodule was found, and the overall density sensory map was slightly higher, which was more consistent with carcinoma in situ or microinvasive adenocarcinoma from the image, and if it persisted, the probability of malignancy was greater

The above figure is April 2022, the lesion has no absorption improvement, the lung boundary and contour are clear, but near the mediastinal pleura, there is no obvious traction, the contractility is not strong, the probability is carcinoma in situ, and microinvasive adenocarcinoma

The above figure is in August 2022, the lesion has not improved from February without any absorption, it is still a high-density ground glass nodule, and the nature of the

Note: The above screenshots are images of 5 mm thick layers and the largest level of lesions

Vigilance: If the provided is not thin layer of image information, even if it is already an electronic version of the image, according to this line of thinking, it seems to be judged to be malignant, and it is recommended that surgical treatment is very correct, because it is always considered carcinoma in situ or microinvasive adenocarcinoma, and the follow-up does not absorb better

Thin layer CT image display and analysis:

The lesion appears, which appears to be ground glass density, slightly uneven

Higher foci density, with microvascular entry (orange arrows)

Lesions show plausibility! The edges shown by the green arrows appear to have a thin ground glass component (like a halo).

The lesion is solid, and the edges shown by the brick-colored arrows are relatively straight; The blue arrow indicates that there is no traction on the adjacent side of the pleura on the mediastinal side, and that the mediastinal pleura is slightly thickened; The yellow arrow indicates that the central density of the lesion appears to be slightly lower

The yellow arrow in the figure above shows the low density in the middle; The blue arrow indicates a thickened mediastinal pleura, with the lesion immediately adjacent to the pleura but no pull-down depression

The image above shows that the blood vessels are moving toward the lesion (orange arrows), the blue arrows still show the relationship with the pleura, and the red arrows show that the edges of the lesions are smooth and there are no other malignant signs

The above illustration shows the blood vessels moving toward the lesion, but there is no entry and no vascular curvature

The orange arrow in the picture above shows more clearly the relationship between the lesion and the blood vessels, which are attached to the walk, do not enter, do not bend, and do not violate

The coronary position shows a high density of lesions, solid nodules, smooth margins, and slightly lower
intermediate density.
There are no malignant imaging features, but rather quite consistent
with granulomatous inflammation.

My opinion:

I started looking at the recent and February, the lesions are like ground glass nodules, dense, clear contours, adjacent to the mediastinal pleura, like tumor properties, from this density, there is a possibility
of microinvasive adenocarcinoma.
Unfortunately, neither of these times is a thin layer of images
.
Later, looking at April, I found that there is a thin layer, this lesion from the thin layer, the density is too high, it is solid, and the density in the middle is slightly lower than the periphery, the tiny blood vessels walk against the lesion, but there is no traction or blood vessel bending, I consider this nodule is a granulomatous inflammation is more
likely.
It is recommended to review the thin layer or right mid-lobe target scan
after half a year.
The above comments are for reference!

Sentiment:

After reading this case, do you dare to give the conclusion of the diagnosis under the lung nodule that only has non-thin CT taken? Thin layer, thin layer, thin layer CT is the key factor to distinguish the benign and malignant lung nodules! The CT examined is not a thin layer, and many times, the benign and vicious judgment of small nodules becomes a joke!

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