The small shadows or nodules in the lungs may be inflammation, tuberculosis, benign tumors or malignant tumors, and their differential diagnosis is more difficult to make, so don't expect your doctor to give you a definitive diagnosis, which is usually a tendency to recommend and give you two choices.
A small shadow or nodule in the lungs is usually a single round or ovoid lung shadow in the lungs with a diameter of less than 10 millimeters. Often doctors recommend 1. a repeat lung CT after systemic anti-inflammatory treatment, and then decide whether to continue observation and follow-up or surgery; in the case of a small nodular lung lesion, regular follow-up may be recommended. 2. the patient is simply advised to opt for surgery.
This is a very difficult choice for the patient or his family, and it should be said that both choices are correct, because the doctor does not know whether the small shadows or nodules in the lungs are benign or malignant, so the patient should be prepared for both.
Some patients have honeycomb-shaped lung shadows, and if they cough up pus and blood for a long time, they should suspect the possibility of bronchiectasis. Bronchial dilatation is the enlargement of the bronchial lumen caused by purulent infection of the bronchial wall, and chest radiographs often show increased lung texture, coarsening, and disorganization. Previously, bronchial iodine-oil angiography was the gold standard for the diagnosis of bronchiectasis, and now spiral CT allows for non-invasive reconstruction of bronchial morphology, enabling a definitive diagnosis. If the lesion is confined to 1-2 lobes and the general condition is good, it should be treated aggressively with surgery, but if the lesion is bilateral and extensive, surgery is not appropriate.
If malignant tumors from other parts of the body metastasize to the lungs, this is metastatic lung cancer. This kind of lung shadow often manifests as single or multiple round shadows, which are hairy glass-like, with clear boundaries, and mostly located in the outer part of both lungs. Most of the patients have no symptoms, at this time, they should actively search for the primary lesion, and after the primary lesion is removed, the single lung metastasis can be surgically removed.
If the lesion is not completely absorbed after treatment of the lung infection, a pneumonic pseudotumor may form. Most patients have a history of previous pneumonia and most are asymptomatic when the lung shadow is detected. If an inflammatory pseudotumor can be diagnosed, it can be left untreated because it is not really a tumor.
Congenital disorders can also cause lung shadows
Congenital developmental abnormalities of the lungs can also cause lung shadows, in addition to the disorders described above. However, they are generally less common, such as lung cysts, lung misshapen tumors, and pulmonary isolation. Lung cysts occur most often in male children and young adults. X-ray chest radiographs are characterized by single or multiple round, thin-walled shadows with well-defined margins, and air-fluid planes are found in the shadows if the cysts are communicating with the bronchial tubes. Typical chest radiographs of pulmonary malformation tumors show " popcorn-like " pulmonary isolation is a congenital abnormality of lung development, and the lung shadow is mostly irregularly triangular, polygonal, round or oval, with sharp edges and uniform density.
As you can see, many benign diseases can manifest themselves as "lung shadows". With the "lung shadow", the patient should actively go to the thoracic surgery, respiratory medicine to clarify the diagnosis. Only with a clear diagnosis can a correct treatment plan be formulated.
At the same time, if the patient's character is introverted, heavy-minded can be early surgery, the character of the more cheerful extrovert can be observed for a period of time; the older recommended observation, the younger can be early surgery.
In short, small shadows or small nodular lesions in the lungs should be clearly diagnosed as soon as possible, the diagnosis time should not be too long, and the early adoption of surgery-based comprehensive treatment, most patients can be cured.
Infectious diseases of the lungs, including:
1, pneumonia: is the source microorganisms (bacteria, mycoplasma, chlamydia, viruses, etc.) caused by lung infections, in addition to X-ray examination of the lungs shadow, the patient has a cough, coughing sputum, fever, chest tightness, fatigue, respiratory distress and other symptoms, and the serious cases can even be infected toxic shock. The most common pathogenic microorganisms are bacteria, the shadow on the X-ray chest film is often flaky, and in severe cases, it will involve the whole lobe of the lungs, and if you do a routine blood test, you can find that the number of white blood cells is obviously elevated. After the application of antimicrobial anti-inflammatory treatment and review of the chest X-ray can be found in the lung shadow significantly reduced, or even completely disappeared, usually 2 weeks of treatment can be cured.
2, tuberculosis: is a special bacteria, that is, tuberculosis mycobacteria caused by lung infection, the incidence of recent years there is a trend of increase. The common parts of the two sides of the upper lungs of the apical and posterior segment and the lower lobe of the dorsal segment, the shadow manifested as scattered pieces of flocculation, in which there can be calcified foci, and sometimes can be spherical foci or corn-like foci, and very rarely can involve the whole of the lobes of the lungs on one side, forming the so-called "destruction of the lungs". Patients often have cough, sputum and hemoptysis, as well as symptoms of tuberculosis poisoning such as low fever in the afternoon, fatigue, night sweats and loss of appetite. If bacillus antacidus is detected in the sputum and the skin tuberculin test is strongly positive, the diagnosis is usually clear. Most patients with tuberculosis are well treated with anti-tuberculosis drugs (remifentan, rifampicin, ethambutol, etc.), but if it is a spherical tuberculosis foci combined with cavities, or "destroyed lungs", it should be surgically resected by a thoracic surgeon.
3, bronchial dilatation: is the expansion of the bronchial lumen caused by purulent infection of the bronchial wall, is an irreversible infection. x-ray chest X-ray shows that the lung texture increased, thickened, disordered, severe bronchial dilatation can be shown as a string of beads like a small translucent area, showing a typical honeycomb-like shadow. Common symptoms are prolonged coughing of purulent sputum and coughing up blood. In the past, bronchial iodine-oil angiography was the gold standard for the diagnosis of bronchiectasis, but nowadays, spiral CT can reconstruct the morphology of the bronchus without any trauma, which has basically replaced bronchial iodine-oil angiography. If the lesion is confined to 1-2 lobes and the general condition is good, it should be aggressively treated with surgery; however, if the lesion is bilateral and extensive, surgery is not appropriate.
4, pulmonary aspergillosis: is a fungal infection of the lungs, that is, putrefactive Aspergillus fumigatus infection, manifested as isolated or multiple spherical foci in the lungs, with a typical "crescent-like bright area", with the change of position, the location of the crescent-like bright area also changed. Most patients have no systemic symptoms, but a few may cough up blood and cough. Surgical resection is appropriate for treatment. The author once encountered a case of postoperative complication of pulmonary aspergillosis, which was cured after the second surgical resection of the lung lobes.
Lung tumors, mainly including:
1, lung cancer: is the most important cause of mental stress in patients with "lung shadow". It occurs in middle-aged and old people, and is divided into central and peripheral types. Most of the shadows are spherical foci with lobulated edges, and some patients have burrs on the edges of the foci. If the center of the foci is necrotic and communicates with the bronchial tubes, eccentric cavities can appear. A centralized lesion that causes bronchial obstruction can also present as a sheet-like shadow similar to pneumonia. Patients may have irritating cough, bloody sputum, chest pain, emaciation, hoarseness, and choking on water. Chest CT examination can clarify the location of tumor and its relationship with surrounding blood vessels; most patients with bloody sputum can find tumor cells in blood sputum; fiberoptic bronchoscopy can find central endobronchial foci and biopsy can be carried out to make a clear diagnosis; peripheral foci can be punctured and biopsy can be carried out to make a clear diagnosis under the positioning of CT. Early stage lung cancer should be treated with surgery-based comprehensive treatment, and advanced lung cancer can be treated with chemotherapy, radiotherapy, traditional Chinese medicine, biotherapy and other comprehensive treatments according to the cell type of the tumor.
2. Lung metastatic cancer: malignant tumors from other parts of the body, such as kidney, liver, ovary, are transferred to lung. The foci are often single or multiple round shadows, hairy glass-like, with clear boundary, mostly located in the outer part of both lungs. Most of the patients have no symptoms and should actively search for the primary lesions. Treatment is based on targeting the primary lesion, and a single lung metastasis can be surgically removed after the primary lesion is removed.
3. Pneumonic pseudotumor: as the name suggests, it is a pseudo "tumor" formed by the incomplete absorption of the lesion after the treatment of inflammation in the lungs, and the edge of the shadow lesion in the lungs is clearer than that of lung cancer. Most of the patients have a history of pneumonia, and most of them do not have any symptoms when they find the lung shadow. Sometimes it is not easy to distinguish it from lung cancer, but CT biopsy can be used to make a clear diagnosis. If the diagnosis of inflammatory pseudotumor can be confirmed, it can be left untreated.
Congenital developmental anomalies of the lungs, mainly include:
1, pulmonary cysts: also called congenital bronchopulmonary cysts, most common in male children and young adults, characterized by congenital malformations of the distal bronchioles, which are classified as single and multiple.X-ray chest radiographs show single or multiple round thin-walled shadows with clear edges, and air-liquid can be detected in the shadows if the cysts are communicating with the bronchi. The cysts are usually asymptomatic for a long period of time. Generally, pulmonary cysts can be asymptomatic for a long time and are often found incidentally on X-ray; when combined with infection, they may present with symptoms similar to those of respiratory tract infections. Because a pulmonary cyst is a dead space, it is not conducive to respiration, and should be surgically removed to avoid various complications.
2, lung misshapen tumor: is the embryonic development of the wrong composition of normal tissue, including fat, connective tissue, cartilage and calcification. Generally, it is an uncoated nodule with a diameter of 1-4cm, and the diameter of the larger one can reach 20cm, which is mostly single, and a few of them are multiple in both lungs. They appear as round or slightly lobulated masses with well-defined margins and may contain multiple calcifications, typically with a "popcorn-like" image. It is usually asymptomatic and is usually found by chance during chest X-ray examination. Treatment is based on local excision, and frozen pathology is performed during surgery if necessary to exclude lung cancer.
3. Pulmonary Isolation: It is a congenital lung developmental abnormality, characterized by a part of embryonic lung tissue isolated from normal lung tissue, forming cystic masses, which can be divided into intralobar and extralobar types. The shadows are mostly located in the posterior segment of the lower lobes of the lungs, and are irregularly triangular, polygonal, round, or oval with sharp edges and uniform density. Intralobar type may be characterized by cough, fever and recurrent lung infections; extralobar type is usually without discomfort and is often detected during routine chest X-ray examination. In most patients, it is difficult to diagnose the disease before surgery, and the diagnosis is confirmed only when abnormal blood vessels are found during surgery. Because the disease often causes recurrent lung infections and ineffective blood shunting, and because the symptoms may worsen with age, aggressive surgical treatment is indicated.
After understanding the above common causes of lung shadow, we can realize that "lung shadow" does not necessarily mean lung cancer, and there are many benign diseases that can also be manifested as "lung shadow". Once a patient finds "lung shadow", he/she should not be overly nervous, but should actively find a specialist doctor (thoracic surgery, respiratory medicine) to make a clear diagnosis, and the doctor will apply other auxiliary examinations according to the specific conditions of the patient, such as chest CT, fiberoptic bronchoscopy, CT localization under puncture, sputum cytology, etc. to further make a clear diagnosis. Once the diagnosis is clear, the doctor will formulate the correct treatment plan.