Archived case 224 · June 29-July 6, 2017
You are shown an axial LDCT (lung window) of a 62-year-old woman with a 39-pack year history of tobacco abuse that reveals a solid, non-calcified, well-defined nearly occluding endobronchial lingular nodule.
What is the appropriate LungRADS score and course of management?
Single unenhanced axial LDCT image (lung window) reveals a solid, non-calcified, well-defined nearly occluding endobronchial lingular nodule. Answer Diagnosis: LungRADS 4A-Additional Testing with PET CT or Tissue Sampling via Bronchoscopy is Recommended
LungRADS 4A-Additional Testing with PET CT or Tissue Sampling via Bronchoscopy is Recommended
Answer
Diagnosis: LungRADS 4A-Additional Testing with PET CT or Tissue Sampling via Bronchoscopy is Recommended
Differential Diagnosis
None
Discussion
Based on the LungRADS system, the lesion in question is a LungRADS 4 and LungRADS 4A in particular because it is a solid non-calcified endobronchial lesion identified on baseline imaging. Although category 4A lesions are only encountered in about 2% of the screening population, the probability of malignancy in such lesions is more than 15%. Thus, additional testing with PET-CT and or tissue sampling would be indicated in this case. Bronchoscopy was subsequently recommended and performed. A diagnosis of typical carcinoid tumor was established. The lesion was subsequently successfully completely excised via laser-guided bronchoscopy without the need for thoracotomy.
References:
1.http://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/LungRADS/AssessmentCategories.pdf
2. https://radiopaedia.org/articles/lung-rads
Original case written by its authors at Virginia Commonwealth University and published at this address as part of a weekly teaching collection. Reproduced here as an archive.