📂 Always review old radiology to assess change over time → stability for 2 years suggests benignity.
🔬 Bronchoscopy not always indicated unless lesion is endobronchial or accessible.
🖥️ If no prior imaging: proceed with CT chest for size, margins, and calcification pattern.
💡 Calcification or intranodular fat = usually benign (e.g., hamartoma).
⚠️ Nodules >3 cm in smokers, especially spiculated with hilar nodes, → high suspicion for malignancy.
🔥 18-FDG PET uptake suggests malignant metabolic activity.
🩺 Tissue diagnosis: percutaneous needle biopsy under radiology guidance (risk: pneumothorax, bleeding).

🚩 Markers Suggesting Malignancy

👵 Age >40 years
🚬 Smoking history or asbestos exposure
👨‍👩‍👦 Family history of lung cancer
📈 Increasing nodule size over time
🚫 Absence of calcification
📏 Size >3 cm
🌀 Irregular/spiculated borders
⬆️ Upper lobe location

🧾 Causes of a Solitary Pulmonary Nodule

Category	Description
✅ Benign Causes	Granulomas: TB, histoplasmosis; often calcified. Hamartomas: Benign, contain cartilage/fat (classic popcorn calcification). Infectious Nodules: Bacterial, fungal, or parasitic. Inflammatory: RA, GPA (Wegener’s granulomatosis). Vascular: AVMs, pulmonary infarcts.
❌ Malignant Causes	Primary Lung Cancer: Adenocarcinoma (most common), SCC, small cell. Metastases: From breast, colon, kidney, etc. Carcinoid tumours: Neuroendocrine, slow-growing but potentially malignant.

CT Lung Nodule

Chest X-ray Nodule

🔎 Investigations

🧪 Bloods: FBC, U&E, LFT, glucose, calcium.
🩻 Chest X-ray: initial detection tool.
🖥️ CT chest: detailed morphology, follow-up at 3–6 months if indeterminate.
🔬 Bronchoscopy: if central or endobronchial lesion.
🪡 Needle biopsy: transthoracic, image-guided.
🔥 PET scan: increased uptake = suspicious.

🛠️ Management

Approach Based on Risk
🟢 Low Risk	Serial CT scans at 3, 6, 12, 24 months. Stable for 2 years → likely benign.
🟡 Intermediate Risk	PET-CT for metabolic activity. Biopsy via bronchoscopy or needle.
🔴 High Risk	Surgical resection (lobectomy or wedge excision). VATS (Video-Assisted Thoracoscopic Surgery) for diagnosis/therapy.
🔄 Follow-Up	Regular imaging surveillance. Oncology referral for malignant nodules (MDT approach).

3 Clinical Cases — Solitary Pulmonary Nodule (SPN) 🌑🫁

Case 1 — Incidental benign granuloma 🟢: A 48-year-old woman, non-smoker, attends A&E with chest pain. Chest X-ray shows a 1.5 cm right upper lobe nodule. CT chest confirms a well-circumscribed, calcified lesion. No symptoms of weight loss or haemoptysis. Teaching: Features suggest a benign granuloma (e.g. healed TB, histoplasmosis). Management is reassurance, no intervention if stable on serial imaging.
Case 2 — Malignant nodule in smoker 🚬: A 64-year-old man with 45 pack-years, presents with mild cough. CXR shows a 2.5 cm solitary nodule in the left upper lobe. CT shows spiculated margins, no calcification. PET-CT is avid. Teaching: Risk factors (age, smoking, spiculated CT) suggest bronchogenic carcinoma. Next step is tissue diagnosis (CT-guided biopsy or bronchoscopy) and staging.
Case 3 — Solitary metastasis 🎗️: A 55-year-old woman with treated breast cancer presents for follow-up. CT shows a 1.2 cm nodule in the right lower lobe, new compared with prior imaging. Teaching: In patients with prior malignancy, a solitary pulmonary nodule could represent metastasis. Requires MDT discussion, biopsy if needed, and management guided by primary cancer status and resectability.

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Solitary Pulmonary Nodule

🫁 About Solitary Pulmonary Nodules (SPN)

🚩 Markers Suggesting Malignancy

🧾 Causes of a Solitary Pulmonary Nodule

🔎 Investigations

🛠️ Management

3 Clinical Cases — Solitary Pulmonary Nodule (SPN) 🌑🫁

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