2 Common causes of a mass on a CXR Benign nodulesPrimary lung cancerMetastatic diseaseLung abscessThere are many other causes, but these are three important ones.Often the history and physical examination will indicate the likely cause.
3 Features of Benign Masses Small (<3 cm)Similar density to bone (i.e. calcified)Well defined marginsAge of patient (<30 = usually benign)No change in size over time…so always compare with previous CXRs if available
5 Here, of course. But how would you describe it accurately? Where is the mass?Here, of course. But how would you describe it accurately?
6 Important points when you a see a mass Where is it?How big is it?Are there any other masses?Are there any other features of malignancy?e.g. rib destructione.g. pleural effusione.g. mediastinal widening (implies enlarged lymph nodes)
7 Describing this mass“There is an ~8cm soft tissue mass at the right hilum. There are no other abnormal features.”
9 “There are extensive bilateral pulmonary masses of varying size.” Describe this CXR“There are extensive bilateral pulmonary masses of varying size.”
10 What is the diagnosis?That depends on the clinical history. In a patient with known malignancy, these are almost certainly disseminated pulmonary metastases
11 Clinical Case: A 19 year old unemployed male is admitted to AMAU with breathlessless and fever. He has venepuncture wounds on his arms.Look at his CXR on the next slide. Try to work out what the diagnosis is.