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Patient Information:
Female 69 years old
Inquiry Questions:
Lung nodules are found one year ago to help diagnose, see if it is malignant
.
Whether or not to take medication:
Yes, bye Fule
Image display and analysis:
After receiving the doctor, I first watched the film from October this year, as follows:
lesions appear, the density is felt too high (pink arrow), which is basically solid; And the edges are blurred (green arrows), which are ground-glass halos with unclear boundaries; Nearby is also not refreshing, with interstitial changes (yellow arrows), distributed
subpleural.
The lesion is adjacent to the pleura, but there is no significant traction depression, and the surrounding lung field is unclear (yellow arrow).
The lesion has vascular entry (orange arrow), but the edge is straighter, and the boundary between the tumor lung appears slightly blurred (green arrow); lack of contractility on the side in contact with the pleura (blue arrow); Not refreshing around (yellow arrow).
The edges of the lesions are straight (brick-colored arrows), lack of contractility (blue arrows), and are too dense, with a solid density (pink arrows), and blurred boundaries of the tumor lung in some areas (green arrows).
The vicinity of the lesion is not refreshing, there is no traction at all at the contact between the lesion and the pleura, and the edge of the lesion is rough
.
The lesions are irregular, lack of contractility, no obvious expansion, high density, and the surrounding is not refreshing
.
The marginal area of the lesion has a ground-glass component, a little, and the outline is not clear
enough.
The density of lesions is uneven, the sensation is high, and the surroundings are not refreshing
.
The sagittal lesion has a vague outline, blood vessels enter, and the surrounding lung tissue is blurred in many places, which appears to have chronic inflammation or interstitial changes (yellow arrows).
The coronary location shows that the lesion density is high, the edges are uneven, and there are burrs, which looks like malignant
at this angle.
Initial judgment of the image:
The overall density of this lesion is too high, basically solid nodules, but the edges are blurred, the boundary of the tumor lung is not clear, lack of contractility, no swelling, the nearby lung tissue is not refreshing, chronic inflammation or interstitial changes, although there are burrs at some levels, but the adjacent pleura is not pulled, the blood vessels enter the position without abnormal thickening feeling, feel that chronic inflammation is more likely, only the coronal position is not very comfortable
.
Later, I looked back at the video from last November:
Lesions appear, ground glass density, the border of the tumor lung is slightly mushy, and blood vessels enter
.
Entry of blood vessels into lesions (orange arrows), burr signs on local edges (purple arrows); The boundary of the overall tumor lung is clear
.
The margins are not clear (green arrows), the density is slightly higher at the contact with the pleura, and the boundary of the tumor lung is clear
.
vascular signs pronounced, nor markedly tapering as they approach the edges (orange arrows); The lesion has a clear border (red arrow) and a little ground glass component around it (green arrow).
The density is slightly not high, the density of ground glass, the surface is uneven, and the middle is a little high-density
.
The pleura appears to have traction (blue arrow) and the boundary of the tumor lung is clear (red arrow).
It is basically pure ground glass, with a few dots and high density, uneven surface, and small spinous processes or burrs locally; There are scattered ground-glass opacities (green arrows)
in the surrounding lung tissue.
The marginal part of the lesion is elongated, but the boundary of the tumor lung is still clear
Image re-judgment:
From the imaging a year ago, it is obvious that it is a ground-glass nodule lesion of the malignant category, the boundary of the tumor lung is clear, there is a local burr sign, there is blood vessel entry, the internal density is not uniform, and there is pleural traction
.
If you compare the before and after this lesion, it is clearly progressive, the density is significantly increased, the overall range is fuller, and the nearby interstitial lesion-like place, which was not obvious a year ago, is not necessarily related to
the nodule.
Follow-up increases the progression of nodules, from ground glass (obviously like malignant ground-glass nodules) to basically solid, that is quite vigilant, this focus is very likely to be malignant, and should be invasive adenocarcinoma is likely, microinvasive adenocarcinoma starts
.
This density is less likely to be carcinoma
in situ.
My opinion:
At first glance, this lesion does not look like malignant, the edges are mushy, and it lacks swelling, but it has blood vessels entering, second, follow-up has progressed, and third, the location is good, I think it is still necessary to consider local incision to rest assured
.
On comprehensive assessment and before-and-after comparison, the likelihood of malignancy is
greater.
Sentiment:
The judgment of benign and malignant pulmonary nodules, ground glass is easier than solid, and it is relatively difficult to be solid about 1 cm (because if it is below 5 mm, it can be followed up anyway, and the image features are not typical).
At this time, proper follow-up observation and before and after comparison are the most important magic weapon to identify benign and malignant nodules! This example is very interesting, I feel that it is benign at first glance, and when it tends to be inflammatory, the analysis of image features can be benign; Looking at last year's film like malignant, its image characteristics can be leaned
towards malignancy.
It shows that when analyzing these image features such as contractility, swelling, edge morphology, peripheral dynamics, and vascular signs, there is a difference between solid nodules and ground-glass nodules, so we cannot just stare at a certain image feature
.
Dynamic observation contrast, detailed feature analysis, and judgment of whether the lesion is benign or malignant should be combined to see
.
Of course, this example is only my opinion at present, and I hope that friends can leave a message at the back of this article after the results, so as to form a closed-loop sharing and interpretation to improve together
.