Differential diagnosis and evaluation of multiple pulmonary nodules
- Jess Mandel, MD
Jess Mandel, MD
- Section Editor — Pulmonary Vascular Disease
- Professor of Medicine
- University of California, San Diego
- Paul Stark, MD
Paul Stark, MD
- Professor of Radiology
- University of California San Diego
- Section Editors
- Nestor L Muller, MD, PhD
Nestor L Muller, MD, PhD
- Section Editor — Pulmonary Imaging
- Professor of Radiology
- University of British Columbia
- Talmadge E King, Jr, MD
Talmadge E King, Jr, MD
- Editor-in-Chief — Pulmonary, Critical Care, and Sleep Medicine
- Section Editor — Interstitial Lung Disease
- Julius R Krevans Distinguished Professorship in Internal Medicine
- University of California, San Francisco, School of Medicine
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".)
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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- DIFFERENTIAL DIAGNOSIS
- Malignant versus benign
- Malignant diseases
- Benign diseases
- - Infection
- - Non-infectious inflammatory conditions
- - Pulmonary AVMs
- - Pneumoconioses
- DIAGNOSTIC EVALUATION
- Computed tomography
- - Serial CT scans
- - Tissue sampling
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS