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study: CT Chest
age: 56 yr.
sex: Female

You Make the Call

History:
56 year old white female with long smoking history and cough. She was told she had a "spot" on the lung by an outside physician and it could be lung cancer, and was referred to KUMC.

PA Chest: Shows a small nodule in the right upper lobe (see marks) which was not seen on a CXR two years ago. It was not visible on the lateral view--but small nodules often are not seen on both views.
Also note hyperinflation of the lungs from emphysema and flattening of the diaphragm. There are also several calcified subcarinal granulomas (old calcified lymph nodes from previous infections).

While you're thinking--how about some normal anatomy on the CT scan.
1. Find the major fissures on the lung windows. Which lobe lies anterior to it and which posterior?
2. On soft tissue windows identify the aortic arch, SVC and trachea.
Now that you are oriented study these scans and try to find the suspected lung nodule.
The tiny nodule on image 25 (arrow) is too small to account for the nodule on CXR-try again.
Look at the magnified views of image 25 on the lower half of the film. See any "bumps" which might account for the "nodule"? Compare with left chest wall in the same area. What is your diagnosis?

HINT: People on long term steroid medication for emphysema develop weakened brittle bones.
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