Lung Masses

Common causes of a mass on a CXR Benign nodules Primary lung cancer Metastatic disease Lung abscess There are many other causes, but these are three important ones. Often the history and physical examination will indicate the likely cause.

Features of Benign Masses Small (<3 cm) Similar density to bone (i.e. calcified) Well defined margins Age of patient (<30 = usually benign) No change in size over time …so always compare with previous CXRs if available

Where is the mass?

Here, of course. But how would you describe it accurately? Where is the mass? Here, of course. But how would you describe it accurately?

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 destruction e.g. pleural effusion e.g. mediastinal widening (implies enlarged lymph nodes)

Describing this mass “There is an ~8cm soft tissue mass at the right hilum. There are no other abnormal features.”

Describe this CXR

“There are extensive bilateral pulmonary masses of varying size.” Describe this CXR “There are extensive bilateral pulmonary masses of varying size.”

What is the diagnosis? That depends on the clinical history. In a patient with known malignancy, these are almost certainly disseminated pulmonary metastases

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.

Multiple ill-defined masses in both lungs

Diagnosis = Multiple cavitating lung abscesses in a intravenous drug user

Some masses are difficult to see… …can you find this one?

Some masses are difficult to see… …a methodical approach to looking at CXRs will reduce the chance of missing small cancers like this one

Where is the mass here?

It is NOT in the lung. Where is it?

Metastasis to right 7th posterior rib This is a rib metastasis. Look closely to see interruption of the rib, which is destroyed and expanded.

Take Home Points There are many causes of lung masses A good clinical history will often suggest the diagnosis A new lung mass in an elderly patient is almost certainly malignant