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As we're interpreting lung cancer screening cts,

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it's always important to have the comparison exams readily

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available to compare new findings

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to understand their significance.

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And so on the left we have our current lung cancer screening

0:13

ct and on the right we have the annual lung cancer screening

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CT from one year ago.

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So we can do side-by-side comparison, like many individuals

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who have a history of cigarette smoking

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and they have lung abnormalities

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and here we see a little bit

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of peripheral paraseptal emphysema,

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but we see some fuzzy ground glass right underneath it.

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So this patient has a combination of emphysema

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and respir, respiratory bronchiolitis,

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interstitial lung disease,

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or respir respiratory bronchiolitis,

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which is a very common inflammatory process

0:44

surrounding the small airways related

0:45

to the inflammation caused by cigarette smoke inhalation.

0:49

And as we scroll down a little bit further,

0:51

you see a discreet than while zest, benign than while zest.

0:56

We also see a new area

0:58

of geographic ground glass opacity in the right

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upper upper lobe anterior segment.

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It was not present on the prior CT examination.

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And as we continue to scroll down, we see areas

1:09

of solid consolidation within it.

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So a mixture of geographic ground glass

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and consolidation that is completely new within the one year

1:18

timeframe Since the comparison ct,

1:21

as we keep scrolling down the lungs,

1:22

we see more evidence of lung disease.

1:24

We see more ground glass opacity

1:26

and see some reticulation of the lung bases.

1:29

This looks like it's been a chronic finding in this patient.

1:32

There's something known as

1:35

smoking related interstitial lung disease due

1:37

to a combination of the types of processes

1:39

that can be seen in the lungs from respiratory bronchitis

1:43

to emphysema to early interstitial fibrotic lung disease.

1:48

And so when we see these types of chronic ground glass

1:51

and reticular changes, it's common

1:53

to call them smoking related ILD mixed in

1:57

with areas of emphysema.

1:58

But as to the lung rans category for this examination,

2:01

we have this geographic new right upper lobe ground gloss

2:04

of consolidation, something that an usual practice

2:07

of interpreting chest cts, we would call pneumonia

2:10

and we're going to call this a lung ran zero

2:12

and recommend the patient come back

2:14

for their next annual ct.

2:17

Well, let's see what happens next.

2:20

This patient does have a followup CT examination.

2:24

They've come back in just under four months timeframe.

2:27

And now we've got the followup examination here on the right

2:31

and it looks like those basler smoking wood ILD changes are

2:35

still there, but that geographic area

2:38

of new ground glass consolidation is completely resolved.

2:41

So now we can call it a lung RADS two

2:43

and we're gonna recommend the patient now come back

2:45

for their next annual screening CT in 12 months.

2:49

So new pneumonia, lung rad zero compared to the prior exam,

2:53

short-term inner fall.

2:54

Follow-up, the abnormality is resolved now back

2:57

to lung RADS two and the patient come back annually in 12

3:00

months for their next screening ct.