Benign lung nodule

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This 67 year old female had severe COPD.  She was found to have lung nodules on her chest CT scan. There was low grade uptake on PET scan.  She underwent a needle biopsy that was negative for malignancy, but sustained severe bleeding and this required transfer to SMH .  Because of severe lung disease, no open biopsy was done.  Approximately 1 year later, she had an open lung biopsy in California and a benign abnormality was discovered. 

Please contribute to the differential diagnosis of these abnormalities.

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7 Responses to Benign lung nodule

  1. Laurie Lerner says:

    These are well circumscribed <2cm, noncalcifiied subpleural nodules seen in both lung fields with no mediastinal lyphadenopathy (at least seen). As we know it is benign, my money is on intrapulmonary lymph nodes although the DDx also could include: sarcoid, rheumatoid nodules, nodular amyloidosis, round atelectasis, atypical coccidiomycosis.

  2. FEL says:

    I would also add benign metastasizing leiomyoma and less likely sclerosing hemangioma since it was benign but was prone to bleeding.

  3. Gough says:

    Pulmonary sclerosing hemamgiomaS. I think there were multiple nodules so hemagioma is probably technically incorrect….show me the money?

  4. DUFF says:

    Pulmonary sclerosing hemangioma is a possiblity, but multiplicity of sclerosing hemangiomas is rare. D/DX as mentioned already, but I would add multiple chondromatous hamartomas to the differential.

  5. SK says:

    How about adding pulmonary AVMs to the differential? These lesions are in the lower lobe and some of these seem to have a feeding vessel. I would have done a contrast CT to evaluate further.

  6. Mary Anne says:

    AVM’s would top my list, especially given lower lobe predominance. Doubt coccidiodomycosis, but residence in California is intriguing…

  7. MKallay-moderator says:

    This is a case of nodular amyloidosis- in the DDX of LL.
    These are indistinguishable from bronchogenic Ca

    Are they prone to bleeding on biopsy? I recall that liver biopsy should be avoided in amyloidosis due to bleeding. David Lynch did refer to bleeding in a case report (Chest 1997:112;535 ) and referenced two reports by Charlie Strange (Chest 1987:92:367 and RA Yood (JAMA 1983: 249:1322)

    Amyloid in the lung comes in 3 varieties: tracheobronchial, nodular and alveolar septal. The latter is associated with paraproteins fro multiple myeloma.

    I had a recent case of a single AVM and will get the image to publish. Usually with dye, the feeding vessel is clearcut.

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