These 2 kinds of lung nodules are very easy to develop into lung cancer!

After reading this article, "lung nodules" and "lung cancer" are no longer stupid and unclear!

Pulmonary nodules usually refer to circular, densely enhanced opacities ≤ 3 cm in diameter within the lungs and can be single or multiple
.

The most important purpose of our study of lung nodules is because many early lung cancers manifest as lung nodules, which can be surgically cured in time (lung cancer is one of the cancers with the highest incidence and mortality rate).

However, lung nodules are very common, far more benign than malignant, and we cannot be scared because of the detection of lung nodules by physical examination CT, which goes against our original intention
.

Dr.
Hao today used a batch of CT pictures to analyze the origin of various pulmonary nodules, hoping to solve the confusion of patients with benign pulmonary nodules and let go of the psychological burden
.

Small nodules formed after trauma

Below is a 30-year-old man who suffered trauma in a car accident, breaking 3 ribs and causing lung contusion and bleeding (traumatic wet lung):

Figure 1

A small piece of lung tissue here in the red arrow was violently torn apart by the car accident, and the small blood vessels ruptured and bleed, forming an uneven high-density shadow; Blue arrows are pneumothorax and subcutaneous emphysema (rupture of the lungs and the spillage of air from the lungs into the chest cavity and muscle spaces).

This degree of trauma was not life-threatening, conservative treatment for 1 week discharged, and later the young man reviewed CT, leaving a small smooth nodule of 3 mm in the lung:

Figure 2

This is a benign solid small nodule, which is formed by incomplete absorption of the hematoma, which does not matter and does not need regular review
.

Inhalation of dust, forming benign small nodules

The picture below is two ladies, the picture on the left is working in the fluorite mine that year, when the conditions were simple and the protection was not in place, long-term inhalation of dust, forming many small nodules in the lungs:

Figure 3

The picture on the right is a female cotton picker, who has long inhaled plant dust, forming many micronodules and cord-like shadows
in the lungs.

Similar pneumoconiosis includes 13 kinds, including silicosis, coal workers' pneumoconiosis, welders' pneumoconiosis, etc
.
In the past, pneumoconiosis was divided into fibrogenic pneumoconiosis (harmful) and non-fibrogenic pneumoconiosis, and silicosis, asbestosis, and talcumbery pneumoconiosis were fibrogenic pneumoconiosis; Inhalation of some metal dust (such as iron, molybdenum), in the lung tissue presents a general foreign body reaction, can be gradually weakened after leaving the dust, less harmful to the human body
.

Inflammation or tuberculosis, forming small nodules, some absorbable

On the left of the figure below is an inflammatory nodule and on the right is a bulb bulb, both irregular in shape, with burrs at the edges, accompanied by pleural traction:

Figure 4

This kind of nodule is sometimes simply from the morphological analysis of CT film, and lung cancer is difficult to distinguish, need to be reviewed after anti-inflammatory treatment, or enhance CT to see the strengthening characteristics of nodules, inflammatory nodules are often significantly uniform strengthening, tuberculosis bulbs are generally not strengthened or annular capsule-like strengthening (pulmonary tuberculosis will destroy internal tissues including blood vessels, causing extensive necrosis), lung cancer is mostly mild to moderate uneven strengthening (tumor blood vessels are few and chaotic).

Some cannot be diagnosed, requiring multidisciplinary consultation, with the help of positron emission tomography (PET-CT) or puncture, or postoperative pathology
.

In the early stages of lung cancer, it appears as small nodules

Malignant pulmonary nodules are the most important and can be cured
with early surgery.
In simple terms, malignant lung nodules can be divided into two categories:

The first, pulmonary nodules
with obvious signs of malignancy.

Like the figure below, mixed ground-glass nodules with clear boundaries, accompanied by pleural traction, consistent with lung adenocarcinoma, should be operated in time:

Figure 5

There is also a kind of lung nodules that gradually increase during follow-up, whether ground-glass or solid nodules, should be paid attention to!

The vast majority of early-stage lung cancers grow slowly, and regular re-examination of lung nodules that cannot be identified is a very practical way to avoid excessive medical treatment and prevent missed diagnosis
.

Dr.
Hao can find a lot of lung cancer that grows from small lung nodules every year, and pick out two fastest to share:

Figure 6

The patient's physical examination in 2016 was still normal, and in 2017, a 3 mm lung nodule was detected, which took two and a half years to grow to >1 cm, and the surgical pathology was lung adenocarcinoma
.

Note: This is almost the fastest of its kind and rare! Therefore, it is beneficial
for high-risk groups to recommend a chest physical examination once a year.

Figure 7

This is an elderly man with a history of smoking, and in more than two years, the lung nodules grew from less than 3 mm to more than 1 cm, and later pathologically diagnosed lung squamous cell carcinoma
.

Regular chest CT physical examination in middle-aged and elderly people can detect these fast-growing malignant lung nodules in time and undergo surgical treatment
.

Just like poisonous weeds, if you find it uprooted in time, it will not flood
.

Finally, I will show you a few lung nodules that have been successfully operated, one with a diameter of more than 3 cm, which already belongs to a mass (the red arrow is the tumor, and the blue arrow is the surgical scar):

Case 1, female, 52 years old, cough, fever, chest examination found 1.
3 cm lung nodules, surgical pathology is lung adenocarcinoma:

Figure 8

Case 2, male, 75 years old, physical examination found left lung nodule, 2.
9 cm, left lower lobe resection for 5 years (pathological type unknown, surgery in the hospital, family only remembers lung cancer, can not describe the specific type, look at tumor morphology, squamous cell carcinoma, adenocarcinoma are possible):

Figure 9

Case 3, female, 61 years old, chest tightness one week detected lung cancer, 3.
5 cm, lobulation, pleural traction, and has invaded the local visceral pleura, the pathology after surgery is lung adenocarcinoma:

Figure 10

Benefiting from the convenience of communication in the Internet era, many readers and friends like to study the diagnosis and treatment of lung nodules, and hope that today's batch of case sharing will be helpful
to everyone.

Author: Wang Junhao

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