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

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As we're scrolling through the lung prima,

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we see some very mild upper lobe predominant central

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lobular emphysema.

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Little tiny holes scattered throughout the lungs

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with no definable walls.

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If a patient hasn't undergone pulmonary function testing

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before, even if they're asymptomatic, uh,

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pulmonary function testing is increasingly being recommended

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for patients who have evidence of either emphysema

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or airway centered small airway disease.

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As a way to begin early treatments

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and as we're scrolling through the lung parenchyma here

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and the right lung, we're seeing an area

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of brown glass opacity or a nonsolid nodule.

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We can measure its size,

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but it's gonna be well under

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that 30 millimeter size threshold that we use in lung rants

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to decide category two versus category three lesions.

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And this one is about 10 millimeters,

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so we keep scrolling down.

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You can see there's a little bit of emphysema next to it

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and sometimes emphysema can be really confounding when

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you're looking at nodules.

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Is it a cystic nodule?

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Is this just a ground glass nodule next to

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an area of emphysema?

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In this case, this low density hole has no wall around it.

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So I wouldn't call this a cyst within a ground glass nodule.

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Just looks like a little bit of emphysema

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that is sitting next to the ground glass nodule

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or the nonsolid nodule.

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So looking for a wall around that low density can help

1:31

and we continue to scroll

1:32

through the lung parenchyma looking

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for other pulmonary nodules or evidence of lung disease.

1:40

Of course, we're gonna look at our soft tissue windows

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and we see this patient has moderately severe corona

1:45

artery calcification.

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Important to including the radiology reports

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and make sure we do any risk factor assessment

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for cardiovascular disease.

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We can do things like measure the ascent.

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ATA here looks a little bit generous and it certainly is.

1:58

It's 45 millimeters normal ascending ATA is up

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to about 40 millimeters in most adults.

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And so whenever we see a dilated ascent ATA 40 millimeters

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or larger, um, we

2:11

will recommend a considering doing an echocardiogram

2:14

to evaluate for aortic valve function.

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And we can also see some calcifications at the aortic root

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that are in the region of the aortic valve.

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And that's a sign this patient could be developing

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calcific aortic stenosis.

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So back to our soft tissue windows.

2:30

We've got this ground gloss nodule.

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We wanna know is it new or has it grown from a prior exam.

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So we're gonna look at some prior exams in this patient.

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On the right we have an exam from three years earlier

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and in the same area.

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We're gonna be very careful to scroll

2:48

and map up the same area, looking for those areas

2:51

of emphysema and the other pulmonary vessels in the region

2:54

to make sure we're covering the same area

2:57

and it was not there

2:58

Three years earlier.

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So it's a new nine to 10 millimeter ground glass nodule

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or nonsolid nodule in the right upper lobe

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for this approximately 10 millimeter ground glass nodule

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that is new since a prior screening several years earlier.

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This makes this a long RADS three category

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for which the followup recommendation is

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to do an interval followup CT using low dose

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technique in six months.

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This patient comes back for their CT a little bit early.

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They came back the three month time point

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and it has completely resolved.

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So this new non-salary ground glass nodule almost likely

3:36

represent an area of focal infection or inflammation.

3:40

It has resolved. It is no longer

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concerning for this patient.

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And from this point on from the CT at left,

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the recommendation would be to follow

3:49

with annual lung cancer screening in 12 months.

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So new ground glass nodule confirm it was not there before.

3:56

Short-term interval followup has resolved.

3:59

We are no longer suspicious for um, an adenocarcinoma

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and this patient goes back

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to continuing their annual CT calendar

4:06

for lung cancer screening in 12 months.