Lung Masses
Common causes of a mass on a CXR
• Benign nodules
• Primary lung cancer
• Metastatic disease
• Lung abscess
There are many other causes, but these are three
important ones.
Often the history and physical examination will indicate
the likely cause.
Features of Benign Masses
• Small (<3 cm)
• Similar density to bone (i.e. calcified)
• Well defined margins
• Age of patient (<30 = usually benign)
• No change in size over time
…so always compare with previous CXRs if available
Where is the mass?
Where is the mass?
Here, of course.
But how would
you describe it
accurately?
Important points when you a see
a mass
•
•
•
•
Where is it?
How big is it?
Are there any other masses?
Are there any other features of malignancy?
– e.g. rib destruction
– e.g. pleural effusion
– e.g. mediastinal widening (implies enlarged
lymph nodes)
Describing this mass
“There is an ~8cm soft
tissue mass at the
right hilum. There are
no other abnormal
features.”
Describe this CXR
Describe this CXR
“There are extensive
bilateral pulmonary
masses of varying size.”
What is the diagnosis?
That depends on the
clinical history. In a patient
with known malignancy,
these are almost certainly
disseminated pulmonary
metastases
Clinical Case:
A 19 year old unemployed
male is admitted to AMAU
with breathlessless and fever.
He has venepuncture wounds
on his arms.
Look at his CXR on the next slide. Try to work out
what the diagnosis is.
Multiple ill-defined masses in both lungs
Diagnosis = Multiple cavitating lung
abscesses in a intravenous drug user
Some masses are difficult to see…
…can you find this one?
Some masses are difficult to see…
…a methodical approach to looking at CXRs will reduce
the chance of missing small cancers like this one
Where is the mass here?
It is NOT in the lung. Where is it?
Metastasis to right 7th posterior rib
This is a rib metastasis. Look closely
to see interruption of the rib, which is
destroyed and expanded.
Take Home Points
• There are many causes of lung masses
• A good clinical history will often
suggest the diagnosis
• A new lung mass in an elderly patient is
almost certainly malignant