Coin lesion

Target: UG medical students.

1. Dr.CSBR.Prasad, M.D.
Coin Lesion
CSBRP-Dec-2012

2. Coin Lesion
Def: Any of various solitary, round,
circumscribed shadows appearing in
radiographic examinations of the lungs
that are believed to be caused by
tuberculosis, carcinoma, cysts, infarcts,
or vascular anomalies.
CSBRP-Dec-2012

3. CSBRP-Dec-2012

4. Coin Lesion
CSBRP-Dec-2012

5. Risk of malignancy increases with the age

Patients who are >50yrs, the probability of
SPN to be malignant is 50%
CSBRP-Dec-2012

6. Solitary Pulmonary Nodule
Common causes:
•Primary lung cancers
•Metastases
•Infections: TB, Pneumonia
•Pseudotumor

Less common causes:
•Lymphoma
•Mesothelioma
•Carcinoid
•Chondroma
•Hamartoma
•Cysts – Hydatid
•Rheumatoid nodule
•Pulmonary sequestration
•Pulmonary infarct
•AV malformation
CSBRP-Dec-2012

7. Solitary Pulmonary Nodule
•SPN requires prompt and accurate Dx
•A nodule that has not changed in size for two
years is nearly always benign
•Rapidly enlarging nodule suggests either
infection or inflammation
•CT scans are helpful in DD behaviour
•SPN requires histological confirmation
•If CT / biopsy fail to confirm the nature of the
SPN, surgical excision should be considered

CSBRP-Dec-2012

8. Solitary Pulmonary Nodule
Clinical features:
Majority are clinically silent
Cough
Cervical lymphadenopathy
Finger clubbing
Source of mets – Abdomen/Breast/Testis
Rash – Vasculitis

CSBRP-Dec-2012

9. Chest X-ray
Must be evaluated carefully:
Presence of emphysema suggests a significant
smoking history
An upper lobe location would suggest a TB
Presence of heart failure in a patient with a SPN at
the horizontal fissure suggests a pseudotumor
Calcification indicates benign lesion
Malignant lesions have shaggy, spiculated or
lobulated margin
CSBRP-Dec-2012

10. Solitary Pulmonary Nodule
Rule-1
A nodule that has not changed in size for
two years is nearly always benign
CSBRP-Dec-2012

11. Solitary Pulmonary Nodule
Rule-2
Rapidly enlarging nodule would suggest
either infection or inflammation

Fast growing tumors are uncommon
CSBRP-Dec-2012

12. Solitary Pulmonary Nodule
Rule-3
A nodule in a patient with a h/o smoking
should be considered malignant until
proven otherwise
CSBRP-Dec-2012

13. Solitary Pulmonary Nodule
Rule-4
Calcification suggests a benign lesion
Patterns of calcification:
A central nidus suggests granuloma
Lamination suggests granuloma – histoplasma
Pop-corn pattern suggests Hamartoma
Multiple punctate pattern – Hamartoma / Granuloma
CSBRP-Dec-2012

14. CSBRP-Dec-2012

15. Encysted effusion
CSBRP-Dec-2012

16. Encysted effusion
CSBRP-Dec-2012

17. E N D
CSBRP-Dec-2012