0:00

Let's take a look at this lung cancer screening CT.

0:03

Here. We're on lung windows

0:04

and as we're scrolling through the upper part of the chest,

0:07

we see some very mild little spotty areas

0:09

of low density holes consistent with some mild emphysema.

0:13

The small airways are looking borderline thick.

0:17

Some areas of centric wall thickening

0:19

instead of circumferential.

0:20

As you can see right here

0:22

and centrally here, circumferential wall thickening.

0:25

So we've got evidence of small airway disease,

0:27

but we find a nodule here in the left upper lobe.

0:31

You take a little bit closer look at this nodule.

0:34

It is irregular solid with a small cystic

0:38

or cavitary component in the middle,

0:41

and this is where we struggle to try

0:43

and decide whether is this a cavitary nodule

0:46

where the soft tissue component is greater than the internal

0:49

cystic component, or is this a cavitary nodule

0:52

with a thick and irregular wall?

0:54

I think if you're struggling to make that distinction,

0:57

either pathway will probably get you to the right place.

1:01

Technically, we would call this a cavitary nodule

1:04

and follow the solid nodule recommendation,

1:07

but since it is a new finding from a prior exam

1:11

or if it's a finding that is on a first time baseline ct,

1:15

I think you're gonna get to the same place whether you file

1:18

the solid nodule recommendation

1:19

or whether you file the cystic nodule recommendation.

1:23

So in this case, if we were

1:24

to file the cystic nodule recommendation,

1:26

it would be a four A with a thick wild cyst.

1:30

It measured seven by 10 millimeters.

1:32

We're gonna continue to look at the rest of the lung

1:35

for any other pulmonary nodules or evidence of lung disease.

1:41

I'm gonna use our MIPS

1:43

and other tools to help us look for nodules.

1:47

And there it is there on the mips, the one

1:49

that we have originally found there.

1:52

So lung RADS four.

1:54

A recommendation would be a

1:56

nodule CT using low dose protocol in three months.

2:00

Now what happens to this patient over time?

2:04

We have CT exams that were three months later,

2:07

the exam in the middle, and then an exam

2:10

that was an additional year and a half later on the loft.

2:14

So we've got a good time interval since the original CT

2:17

where we found this cavitary nodule carefully matching up

2:20

the blood vessels and the adjacent structure.

2:23

So here's the cavitary nodule or thick walled cyst.

2:27

We see that on the first followup CT at three months,

2:29

it's almost completely resolved

2:31

with small little nodular area left here,

2:34

but almost completely gone.

2:36

And by the CT that was about a year and a half later.

2:40

There's just the tiniest little residual area

2:43

of nodularity here.

2:45

So good result for the patient thick walled cystic lesion

2:48

versus a cavitary lung nodule except either one will

2:52

probably get you to the right place in terms

2:53

of patient management.

2:55

It resolved thankfully

2:56

for the patient on the three month ct.

2:58

Most likely this is an infectious process that has resolved

3:02

with or without any medical intervention.

3:04

And now this patient continues their lung cancer screening

3:07

journey with an annual low dose CT in 12 months.

3:10

From here and out.