Multiple Well-Defined Nodules

Sudhakar Pipavath, MD

DIFFERENTIAL DIAGNOSIS

Common

Less Common

Rare but Important

ESSENTIAL INFORMATION

Key Differential Diagnosis Issues

Nodules of variable size indicate lesions growing at different rates (metastasis) or are temporally heterogeneous (septic emboli)
Cavitary nodules indicate metastasis, septic emboli, or Wegener granulomatosis
Calcified nodules indicate healed varicella or sequela of histoplasmosis or TB

Helpful Clues for Common Diagnoses

Metastasis
- Nodules of varying size
- Known primary
Granulomatous Infection
- Histoplasmosis: Calcified nodules, splenic granulomas
- Coccidioidomycosis and cryptococcosis: Noncalcified nodules
- Tuberculosis: Travel history; history of recent immigration
Septic Emboli
- Nodules may evolve into cavitary nodules and could be temporally heterogeneous
Wegener Granulomatosis
- Tracheal involvement with diffuse wall thickening in addition to lung nodules
- C-ANCA positive
- Renal and paranasal sinus involvement

Helpful Clues for Less Common Diagnoses

Pulmonary Langerhans Cell Histiocytosis
- Almost always in cigarette smokers
- Combination of nodules and irregular lung cysts with upper lung predominance
Varicella Pneumonia
- Multiple small, randomly distributed, calcified nodules
Sarcoidosis
- Presence of enlarged calcified or noncalcified mediastinal and hilar lymph nodes
Lymphoma
- Associated mediastinal lymphadenopathy
- Risk factors such as Sjögren syndrome, immunosuppression, solid organ transplantation

Helpful Clues for Rare Diagnoses

Tags: EXPERTddx: Chest

Aug 8, 2016 | Posted by drzezo in CARDIOLOGY | Comments Off

Thoracic Key