CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSISEISENBERG

1. 7Solitary Pulmonary Nodule on
Computed Tomography

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig C 7-1 Benign calcifications. Diffuse
punctuate calcifications in a large (6 cm),
lobulated carcinoid.17

4. • Fig C 7-2 Calcified metastasis mimicking hamartoma. Multiple
punctuate calcifications in a mass (arrow) in the right lower lobe. A
biopsy obtained because of prior resection of the rectum for a
malignancy revealed a metastatic adenocarcinoma.21

5. • Fig C 7-3 Malignant calcification. (A) Amorphous
calcification. (B) Peripheral punctuate calcification
consistent with an “engulfed” granuloma. (C)
Diffuse high-attenuation and lobulated contour in
metastatic osteosarcoma.22

6. • Fig C 7-4 Granuloma. Soft-tissue nodule with central
calcification in an asymptomatic man. Note the eccentric
calcification within the nodule.22

7. • Fig C 7-5 Aspergillosis. Thin-walled cavitary
nodule in the right lung of a patient with
leukemia.3

8. • Fig C 7-6 Blastomycosis. Round, well-circumscribed left
upper lobe mass with irregular borders in a heavy smoker.
After a CTguided biopsy was inconclusive, the patient
underwent left upper lobectomy and mediastinal lymph
node dissection for suspected lung carcinoma.23

9. • Fig C 7-7 Lung abscese (blastomycosis). Large
apical thick-walled cavitary lesion in an acutely
ill patient.23

10. • Fig C 7-8 Hamartoma. (A) Sharply marginated
lesion with small focal areas of calcification
and fat.22 (B) Characteristic calcification of a
hamartomatous nodule in another patient.16

11. • Fig C 7-9 Chondrohamartoma. Lobulated nodule
with central popcorn-like in the right upper lobe
(Reprinted from Bennett LL, Lesar MSL, Tellis.
Multiple calcified chondrohamartomas of the
lung: CT appearance. J Comput Assist Tomgr
9:180-182, 1985, cited in 24).

12. • Fig C 7-10 Lipoid pneumonia. (A) Lung
windowing shows a speculated mass in the
left lower lobe. (B) Mediastinal windowing
demonstrates that the mass contains fat
attenuation, consistent with lipid deposits in
the legion.

13. • Fig C 7-11 Intralobar sequestration. Lobular,
well-marginated nodule with homogeneous
attenuation in the right lower lobe.22

14. • Fig C 7-12 Arteriovenous malformation. (A) Feeding artery (arrow)
and an enlarged draining vein (arrowhead) associated with a right
lower lung nodule. (B) Scan at a lower level shows the nidus of the
malformation (Reprinted from Swensen SJ, Brown LR, Colby, et al.
Lung nodule enhancement at CT: prospective findings. Radiology
201:447-455, 1996, cited in 24).

15. • Fig C 7-13 Mucoid impaction. Characteristic V-
shaped structure.24

16. • Fig C 7-14 Segmental bronchial atresia. Branching
tubular area of increased attenuation in the right
lower lobe as well as pulmonary parenchyma
with lower-than-expected attenuation. This
constellation of findings in teenager was
considered so characteristic of segmental
bronchial atresia that no further work-up was
performed.22

17. • Fig C 7-15 Amyloidoma. Solid mass adjacent to the
spine that contains amorphous calcification.25

18. • Fig C 7-16 Non-small cell cancer. (A) Lobulated
and speculated nodule in the right lower lobe.
(B) In another patient, there is eccentric
cavitation within a speculated upper lobe
nodule.22

19. • Fig C 7-17 Solitary metastasis. Smoothly
marginated 1 cm peripheral nodule in a
patient with bladder cancer.22

20. • Fig C 7-18 Ossified metastasis. This left upper
lobe nodule containing what appears to be
dense calcification (arrow) proved to be a
metastatic osteosarcoma.21

21. • Fig C 7-19 Bronchioloalveolar carcinoma. Poorly
marginated nodule in the right mid lung containing
small focal areas of low attenuation, an appearance
highly suggestive of bronchoalveolar cell carcinoma.22

22. • Fig C 7-20 Carcinoid. Well-defined,
homogeneous mass in the right upper lobe.17

23. • Fig C 7-21 Neuroendocrine carcinoma. Large
mass containing punctuate calcifications
(arrowhead) and low attenuation areas
related to necrosis. Note the right
paratracheal lymphadenopathy.25