विवरण
A comprehensive approach to lung nodule management involves high-resolution computed tomography (HRCT) for precise characterization, aided by computer-aided detection (CAD) systems. Adhering to Fleischner Society guidelines guides decision-making based on nodule size, morphology, and patient history. Integration of artificial intelligence enhances analysis and risk prediction. Multidisciplinary collaboration among radiologists, pulmonologists, and oncologists is essential. Regular follow-up imaging ensures effective monitoring, allowing for timely intervention and improved outcomes in lung nodule cases.
सारांश
- The speaker discussed lung nodules, defining them as lung opacifications less than 3 cm, while masses are larger. The presentation focused on a case study of a 78-year-old female admitted for breathlessness, cough, and altered sensorium, complicated by diabetes, hypertension, triple vessel disease, and CKD.
- Initial diagnosis was cardiac failure, but persistent hypoxia led to a CT scan revealing a lung nodule and mosaic attenuation, suggesting pulmonary hypertension. The patient was initially managed with NIV, corticosteroids, diuretics, and nebulization and discharged with home oxygen and NIV.
- The nodule was a solid, 11 mm nodule in the right upper lobe with smooth margins. A multidisciplinary team decided to stabilize the patient before further evaluating the nodule. A risk assessment showed a moderate probability (19%) of malignancy, leading to a PET scan.
- The PET scan showed intense uptake of FDG in the nodule, indicating potential malignancy. A Mayo score indicated a high probability of malignancy (65.8%). The decision was made to pursue liquid lung biopsy due to the patient's high risk for invasive procedures.
- The liquid biopsy revealed a positive K-ras mutation, confirming malignancy. The tumor board recommended SBRT (stereotactic body radiation therapy) in five fractions for curative intent. The patient is currently undergoing radiation therapy.
- The speaker emphasized the importance of peripheral blood examination for high-risk patients, the need for comprehensive nodule evaluation, and the use of MDT (multidisciplinary team) for treatment planning. Common causes of lung nodules include both benign conditions like tuberculosis and granulomas, and malignant tumors, with PET scans aiding in differentiation. Risk assessment for malignancy utilizes tools like the Herder model and Mayo Clinic calculators, considering factors like nodule characteristics and patient age.
- Lung nodules can present as ground-glass opacities, partially solid, or solid. Ground-glass opacity refers to a faint opacity on chest scans that allows underlying structures to be partially visible. Key takeaways included high suspicion for nodules in elderly patients, the need for consistent follow-up, and the value of MDT approaches.
नमूना प्रमाण पत्र
वक्ताओं के बारे में
डॉ दीपक मुथरेजा
Head of Department Pulmonary Medicine, AMERICAN ONCOLOGY INSTITUTE
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