A 64-year-old man comes to the physician for evaluation prior to right total hip arthroplasty. He has a chronic cough with a modest amount of sputum production, which he attributes to smoking. He otherwise feels well. His chronic medical conditions include hypertension, coronary artery disease, and severe degenerative joint disease. He has an 80-pack-year smoking history and currently smokes one and a half packs of cigarettes daily. A chest x-ray taken about a week ago reveals a 2-cm pulmonary nodule in the left upper lobe. Which of the following clinical or radiographic features suggests a benign cause of the pulmonary nodule?

Question

A 64-year-old man comes to the physician for evaluation prior to right total hip arthroplasty.  He has a chronic cough with a modest amount of sputum production, which he attributes to smoking.  He otherwise feels well.  His chronic medical conditions include hypertension, coronary artery disease, and severe degenerative joint disease.  He has an 80-pack-year smoking history and currently smokes one and a half packs of cigarettes daily.  A chest x-ray taken about a week ago reveals a 2-cm pulmonary nodule in the left upper lobe.  Which of the following clinical or radiographic features suggests a benign cause of the pulmonary nodule?

Quizplus · Accepted Answer

Explanation: Clinical and radiographic features can be useful in differentiating benign from malignant nodules to help avoid unnecessary invasive biopsies or procedures. Certain patterns of calcification within the pulmonary nodule are strongly suggestive of benign lesions, including popcorn, concentric or laminated, central, and diffuse homogeneous calcifications. Popcorn calcification is characteristically seen on radiographic imaging in patients with pulmonary hamartoma. Eccentric calcification (area of asymmetric calcification), as well as reticular or punctate calcification, should raise suspicion for malignancy (Choice A). (Choice B) Hoarseness of voice is suspicious for recurrent laryngeal nerve entrapment, causing vocal cord paralysis. Growing malignant lesions are more likely than the more stable benign lesions to cause nerve entrapment. (Choice C) The presence of a hard node in the axilla is a sign of metastatic disease, suggesting malignancy. (Choice E) Spiculated margins are suggestive of malignancy. Benign nodules usually have smooth borders. Educational Objective: Popcorn calcification (hamartoma) or concentric, central, or diffuse homogeneous calcification on radiographic imaging of a pulmonary nodule is suggestive of a benign etiology. Eccentric, reticular, or punctate calcification should raise suspicion for malignancy. References: The calcified lung nodule: What does it mean? (http://www.ncbi.nlm.nih.gov/pubmed/20582171)

A 64-Year-Old Man Comes to the Physician for Evaluation Prior