# New Lung Nodule
(High Risk: >2cm, >60yo, current smoker, upper lobe, spiculated; Low Risk <0.8cm, <40yo, never smoker, lower/middle lobe, smooth contours)
-- History: *** h/o PNAs, smoking (pack years, types, quit), radon, asbestos
-- Clinical: *** SOB, cough, hemoptysis, hoarseness, dysphagia
-- Exam: *** decreased breath sounds, horner syndrome, SVC syndrome, clubbing, focal neuro deficits (CNS mets),
-- Data: *** prior chest imaging, CXR, CT Chest, biopsy
-- Etiology/DDx: *** NSCLC (adenocarcinoma, SCC), small cell carcinoma, metastasis (multiple nodules), hamartoma, TB, sarcoid
The patient's HPI is notable for ***. Exam showed ***. Labwork and data were notable for ***. Taken together, the patient's presentation is most concerning for ***, with a differential including ***.
-- High risk gets surgical excision; If >0.8cm FDG-PET or biopsy then either monitoring via CT scan q2-3 year or surgical excision
-- Tissue: plan to biopsy *** (node, metastatic site, primary lung mass)
-- Imaging: *** (staging scans - CTAP and CT chest, MRI brain)
-- Other: Liquid Biopsy per institutional protocol - Guardant
-- Supportive Tx: dex for vasogenic edema
-- Outpatient follow-up: oncology, radiation oncology, PFTs if surgery possible
PDF coming soon!
Compare to old imaging. If concerning features, get a biopsy - start with metastatic deposit (liver, node, etc), or the primary either via bronchoscopy or via trans-thoracic biopsy. Staging scans include CTAP, CT chest, and MRI brain. Many institutions will send off liquid biopsies to increase the sensitivity for picking up targetable mutations (along with the samples from the primary biopsy). Ensure the patient has adequate oncology follow-up planned.