is for medical professionals to read only for reference
, and you can learn and remember!
A, a male, 42 years old, found that had multiple nodules in the lower lobe of the right lung. Many doctors considered early lung cancer and suggested surgery. After coming to my clinic, I felt doubtful and suggested that he take a slower look and then make a decision. The facts of the subsequent follow-up review proved that this "slow down" was very slow, and he saved his right lower leaf. Let’s take a look at his image performance:
This is from August 2021:
Figure 1
▌ Lesion 1:
light ground glass nodules, clear contour, small jagged borders, and a little bit in the middle, high density (considering blood vessels).
Figure 2
lesions have microvascular entry (orange arrow), tumor lung boundaries are clear, ground glass components at the edges (green arrows), small burrs are locally (purple arrows), and pleural gap signs exist (yellow arrows: close to the pleura, but does not affect pleural , and there is no pleural thickening )
Figure 3
lesions have high density, uneven surface, microvascular entry (orange arrows), fine burrs (purple arrows), pleural gap signs, overall clear contour (red arrows)
Figure 4
This layer shows that the overall outline of the lesion is slightly blurred, and it feels a bit like a dizzy sign (blue arrow); the pleural gap sign exists (yellow arrow); fine burrs (purple arrow)
Figure 5
shows that the lesion surface is uneven and has burrs, but the burrs between the pleura seem to lack strength, not like the feeling of a sharp knife stabbing around
Figure 6
The blood vessel is close to the lesion, and the surface of the lesion is uneven and has burrs, but the blood vessel is not affected by pulling
Figure 7
The blood vessel is adjacent to the lesion and is not affected. The lesions themselves have uneven density and uneven surfaces, which look uncomfortable.
Figure 8
This layer of lesions are slightly scattered, with vascular edges; there are pleural gaps, fine burrs,
Figure 9
Microvascular entry (orange arrow); there are fine burrs (purple arrow); there are slightly ground glass components at the edges (green arrows)
Figure 10
▌ Lesion 2:
is also in the lower right lobe, with a high density and a not smooth surface. The above picture shows that the density in the middle is slightly lower, is it necrosis? (Blue arrow); there are still burrs at the edges (purple arrows), and the overall outline is clear (red arrows).
Figure 11 shows that the edge of the lesion is relatively straight, and there is a lack of swelling
Figure 12 There is blood vessel entering (orange arrow)
Figure 13 The density is uneven, and it looks messy
Figure 14 The outline is not clear, the ground glass part is too light
Image impression and thinking
lower right multiple nodules, mixed ground glass density, not very dense. However, blood vessels enter, surface uneven and burrs are present, overall overall contour is clear, pleural gap signs exist, and ground glass components are found at the edges. It seems to be more consistent with early lung cancer. This is also the reason why many doctors recommend their surgery.
But I think there are two more doubts about :
1 is that the lesion 1 feels dizzy at a larger level, and the outline is not very clear. This is not clear because of burr infiltrating images;
2 is that the lesions are multiple lesions in the lower right. We know that primary cancers in lungs are easily manifested by ground glass, while solid density is relatively rare. Moreover, both lesions are still small. Although there are many malignant signs, some levels are still not very consistent. The most important thing is that the larger layers have a halo. So at least the risk is not too great. My opinion is to follow up appropriately before making a decision.
follow-up review
December 2021 review:
Figure 15
Lesion 2 has not disappeared, but it feels that the density is a bit weak. It turns out that it is basically real, but now there is a harmonious place in the middle that is empty. At least there is no progress
Figure 16 Lesion 2 is significantly reduced
, so I feel much more at ease, at least the follow-up risk is low. The possibility of surgery is less.
May 2022 Re-examination:
Figure 17 Lesion 2 has been basically absorbed, only a little
Figure 18 Lesion 1 density has dropped to similar to pure ground glass nodules
Let’s look at the comparison when it was initially discovered and at this time:
Figure 19
has significantly improved absorption! Will anyone still think it is early lung cancer at this time?
insights:
image judgment of lung nodules, you cannot be entangled in a certain image feature or part of the image feature. In this case, there are indeed many characteristics that are malignant, but we decided whether to intervene surgically. In addition to looking for malignant special films on the image, we also need to see if there are any inconsistencies or areas that cannot be explained. In this case, there are many symptoms, and some levels are dizzy, and the lesion 2 swelling is also a little poor.
Of course, the key is the risk, and whether it can be observed. If appropriate follow-up does not affect the prognosis, it is also very important to make a decision after follow-up. lung nodules don’t really need to be discovered and everything is over. Sometimes follow-up will surprise you, even if there are many malignant imaging characteristics.
More practical knowledge of respiratory clinical?
Come and " Doctor Station APP" Take a look 👇
Source of this article: Ye Jianming's Nodules
Author of this article: Ye Jianming
Editor: Peng Jianping Dai Dai
Copyright statement
This article is reproduced. Welcome to forward the circle of friends
- End -
Request for manuscripts
Medical Respiratory Channel welcomes your submission!
https://titan.yishengzhan.cn/#/public_contribution
Please fill in the real information according to the call for papers
*The medical community strives to ensure the accuracy and reliability of the published content when it is approved, but does not make any commitments and guarantees for the timeliness of the published content, as well as the accuracy and completeness of the cited materials (if any), and does not assume any responsibility arising from such content being outdated, the possible inaccuracy or incompleteness of the cited materials. Please check separately when using this or using it as the basis for decision-making.
