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 and Critical Care Medicine
- Section Editor — Interstitial Lung Disease
- Dean, School of Medicine
- Vice Chancellor, Medical Affairs
- University of California San Francisco
- Deputy Editors
- Geraldine Finlay, MD
Geraldine Finlay, MD
- Senior Deputy Editor — UpToDate
- Deputy Editor — Pulmonary, Critical Care, and Sleep Medicine
- Associate Professor
- Tufts University School of Medicine
- Susanna I Lee, MD, PhD
Susanna I Lee, MD, PhD
- Deputy Editor — Radiology
- Associate Professor of Radiology
- Harvard Medical School
- Massachusetts General Hospital
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 of the incidental 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 intrapulmonary lymph nodes [1-3].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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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