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Here we have a patient who's been undergoing serial lung

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cancer screening CT exams

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and comes in having skipped a year due

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to the Covid to 19 pandemic.

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So they're two years since their last annual screening ct.

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As we take a look, starting at the apex,

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we see a calcified granuloma right here,

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solidly calcified granuloma,

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which we can look at are different windows to confirm.

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And now we're starting to see some ill-defined, patchy

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round glass and part solid nodularity in the left upper

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lobe multifocal.

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And the further we're scrolling down,

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we're getting into an area of

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geographic dense consolidation here along the periphery.

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More of this ground glass throughout the left upper lobe.

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A lot of it is distributed along the bronchovascular bundles

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and this larger area of ground glass here, maybe

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with a little bronchiectasis in the middle of it, kind

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of wavy, slightly dilated bronchus.

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And we're saying the same type of findings here

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behind the major fissure

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and the superior segment of the left lower lobe as well

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as the anterior aspect or anterior basal left lower lobes.

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We're seeing multifocal round glasss

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and part solid nodularity with

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that single larger area anteriorly in the left upper lobe,

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not seeing anything in the right lung.

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So we kind of got low bar distribution left lung

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and our sagittal

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and coronal images can help us just see this

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in a better distribution relative to the location

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of the fissures as we can see here in the left upper lobe

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and here in the left lower lobe.

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So very important is gonna be for us to compare this

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to prior cts.

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So we look back at the CT the patient had

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in 2019, two years earlier,

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and it looks like all that abnormality is new,

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so new in two years.

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If this was outside of the screening setting,

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we would consider this infection peronial, ground glass,

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patchy consolidation in the left lung only,

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and we would call it infection

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and recommend that as our interpretation

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to the referring physicians in the setting

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of lung cancer screening.

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We often get asked, well, how do you know that one

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of these ground gloss

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or part solid nodules is in the lung cancer?

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And that's always the conundrum

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in the lung cancer screening setting.

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We recommend treating with antibiotics whether they do

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or don't have signs or of infection, a course

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of antibiotics, and then repeating the examination

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in one to three months.

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So I've got the current exam that we're looking at

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with the patient here for the lung cancer screening exam,

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showing us what looks like infection.

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We compared it to the comparison exam from two years

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earlier and it's new.

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But again, we're thinking could any one

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of these little areas of nodularity be a small cancer

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that's developed in the last two years since

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the last screening exam?

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So we recommend that follow up lung cancer

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screening CT in one

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To three months and we call it a long red zero.

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And the patient here did come back and about a month

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and a half later, so within that one

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to three month timeframe

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and most of the abnormality has completely resolved all

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of those multifocal ground glass

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and part solid areas of bronchovascular nodularity resolved

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were left with an area of focal bronchiectasis,

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which we had seen some of that bronchiectasis at the time

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of pneumonia and a little bit of brown glass

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and nodularity here.

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The amount of nodularity is in the lung RADS two category.

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So our recommendation for this CT would be

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to bring the patient back in 12 months

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to continue their annual lung cancer screening journey if

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they remain eligible.

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So again, if it looks like infection, call it infection,

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give it a long ran zero score

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and have the patient come back in one to three months,

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usually after course of antibiotics to confirm

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that the abnormality has nearly completely resolved

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or completely resolved

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so you can make the next lung cancer screening.

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Lung rans recommendation.