Evaluation and management of solitary and multiple pulmonary nodules.

摘要: The evaluation and management of a patient with an SPN is guided by principles that were derived from earlier surgical studies. Stability or no growth for at least 2 years, the presence calcium in characteristic patterns, age less than 35 years without any associated risk factors are reliable indicators benign process. Fluoroscopy localized tomography helpful SPN. If nodule still considered indeterminate, CT scanning, use thin section cuts through nodule, now widely employed. present pattern, benign. very dense more phantom reference has high likelihood being Nodules approximately 25% these nodules will be Computed scan chest upper abdomen indicated patients previous history malignancy when there suspicion malignant. further SPNs indeterminate after examination controversial. Some recommend tissue biopsy via transbronchoscopic transthoracic approach, whereas others immediate thoracotomy. Observation certain situations chance quite low, not operable candidate, refuses invasive evaluation. physician's role to educate advise. physician must aware patient's anxieties, fears, attitude provide opportunity active participation decision-making Multiple pulmonary most commonly encountered metastatic disease lungs. Other diseases as multiple include infections, arteriovenous malformations, Wegener's granulomatosis, lymphoma. usually history, physical examination, laboratory findings.