1.5 CM Pulmonary Nodule in a smoker! - USMLE Forums
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  #1  
Old 09-13-2011
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Lungs 1.5 CM Pulmonary Nodule in a smoker!

50 year old male, got a chest X ray, as part of routine tests for new job, chest x ray showed pulmonary nodule of 1.5 cm. The patient has no clinically significant complains, his other lab values within normal range. He has long history of smoking. What is the next best step in the management of this patient?
  • Look for an old chest x ray from the patient.
  • Do bronchoscopy.
  • CT scan.
  • Repeat the chest X ray every 3 month to see if there is a change of size.
  • Do open lung biopsy.
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  #2  
Old 09-13-2011
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Look for an old chest x ray from the patient.
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  #3  
Old 09-13-2011
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old chest x ray
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Old 09-13-2011
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Compare if this is a new nodule or if its old... if its old then its benign.. so see old XR.
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Old 09-13-2011
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You are correct guys. The best next step to look for old X ray.
Here is a summary for the management of lung nodule, please feel free to add.
The next step: look for old chest X ray. If it is present in the old chest X ray (more than couple of years) & stable in size (specially in low risk patient), we do nothing about it, we may do another X ray to confirm that it does not change size. Most of these cases due to old infection ex Blastomycosis (in the Midwest Us), Coccidioidomycosis (in the west), Histoplasmosis (in the south & some part of the east coast).
If no old chest X ray, or the nodule was not there:
You have to decide whether the patient is high risk or low risk patient.
Low risk patient: no smoking history, relatively young < 40 to 45 years, no complains. Follow the patient with Chest X ray every 3/12 for 2 years, if no change in size, then we stop.
If high risk person: do open lung biopsy & remove the nodule.
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Oncology-, Pulmonology-, Radiology-, Step-2-Questions, Surgery-

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