The calcified lung nodule: What does it mean?

Abstract

The aim of this review is to present a pictorial essay emphasizing the various patterns of calcification in pulmonary nodules (PN) to aid diagnosis and to discuss the differential diagnosis and the pathogenesis where it is known. The imaging evaluation of PN is based on clinical history, size, distribution and the gross appearance of the nodule as well as feasibility of obtaining a tissue diagnosis. Imaging is instrumental in the management of PN and one should strive not only to identify small malignant tumors with high survival rates but to spare patients with benign PN from undergoing unnecessary surgery. The review emphasizes how to achieve these goals. One of the most reliable imaging features of a benign lesion is a benign pattern of calcification and periodic follow-up with computed tomography showing no growth for 2 years. Calcification in PN is generally considered as a pointer toward a possible benign disease. However, as we show here, calcification in PN as a criterion to determine benign nature is fallacious and can be misleading. The differential considerations of a calcified lesion include calcified granuloma, hamartoma, carcinoid, osteosarcoma, chondrosarcoma and lung metastases or a primary bronchogenic carcinoma among others. We describe and illustrate different patterns of calcification as seen in PN on imaging.

Malignant Pleural Mesothelioma at a Young Age

“…(7) plevral efüzyon olmadan miliyer, metastatik, parankimal metastazlar ile saptanan mezotelyoma olguları tanımlanmışlardır. Akciğerde multipl kalsifiye nodüllerin varlığında; enfeksiyonlar (miliyer tüberküloz, histoplazmozis, suçiçeği), pnömokonyozlar, hemosiderozis, amiloidoz, metastatik pulmoner kalsifikasyon, alveoler mikrolityazis ve metastaz akla gelmelidir (8). Olgumuzda da her iki akciğer parankiminde bazıları kalsifik multipl nodüller izlenmiştir.…”

Pulmonary inflammatory myofibroblastic tumor mimics lung cancer

“…Punctate and eccentric intratumoral calcification may be considered as malignant features. 13 Metastasis, primary thoracic sarcoma, and carcinoid are the main differential diagnoses. 13 It is quite difficult to differentiate IMT from malignant tumors, especially when the tumor is large and invading the surrounding structure, as in our first case.…”

Misdiagnosis Murder: Disguised TB or Lung Cancer?

“…Opacities can be non-specific indication with a broad aetiology for any of these lung ailments including PTB, pneumonia, LC, bronchitis, sarcoidosis, upper respiratory infection etc. 5 Calcified nodular granulomas/lesions, fibrotic scars and enlarged lymph nodes in TB infected lungs may be recognized on X-ray film which could imitate lumps of LC. 5 Furthermore, enlarged lymph nodes and pleural effusion are common features for both the diseases.…”

“…5 Calcified nodular granulomas/lesions, fibrotic scars and enlarged lymph nodes in TB infected lungs may be recognized on X-ray film which could imitate lumps of LC. 5 Furthermore, enlarged lymph nodes and pleural effusion are common features for both the diseases. Here, physicians need to carefully review the diagnosis and relate it with existing symptoms and patients history of TB infection or LC.…”

“…6 Investigational clinical and radiological attributes indicative of LC, such as opacification of air-spaces of lungs, pulmonary consolidations with irregular margins, thick-walled cavities and parenchyma infiltrate with elevated metabolic activity on the CT and PET scan are also similar for PTB4. 5 The most suitable and inexpensive way to evade misdiagnosis is to examine each and every patient suspected with PTB and also having risk factor history for LC, is sputum analysis for mycobacterium (AFB staining) and tumor cells (Cytology). Biospsy or lymph node aspiration fluid can be used for cytology or microbiological studies (AFB Staining, microscopy, PCR and bacterial culture) further authenticate the diagnosis results.…”