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Differential diagnosis and evaluation of multiple pulmonary nodules

INTRODUCTION

The etiology of multiple pulmonary nodules can usually be determined with the help of a thorough history and physical examination. However, further testing is sometimes required for diagnosis, which may include imaging tests and/or a biopsy. The differential diagnosis and diagnostic evaluation of multiple pulmonary nodules are reviewed here. The approach to a solitary pulmonary nodule is discussed separately. (See "Diagnostic evaluation and management of the solitary pulmonary nodule".)

DIFFERENTIAL DIAGNOSIS

Malignant versus benign — Multiple pulmonary nodules may be caused by malignant or benign diseases.

In patients without a known primary malignant tumor, the following characteristics help differentiate multiple malignant nodules from multiple benign nodules:

Multiple pulmonary nodules that are ≥1 cm in diameter or detected by conventional chest radiography are most likely due to metastatic disease from a malignant solid organ primary tumor [1,2].

Multiple pulmonary nodules that are <5 mm in diameter, juxtaposed to either the visceral pleura or an interlobar fissure, and detected incidentally, are more likely to be benign lesions, such as granulomata, scars, or intraparenchymal lymph nodes [1-3].

             

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Literature review current through: Oct 2014. | This topic last updated: May 9, 2014.
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