Journal Information
Vol. 1. Issue 4.
Pages 315-328 (July - August 1995)
Share
Share
Download PDF
More article options
Vol. 1. Issue 4.
Pages 315-328 (July - August 1995)
ARTIGO ORIGINAL
Open Access
Estratégia diagnóstica do nódulo pulmonar solitário
Visits
5198
M.F. Baganha(1), M.A. Sousa(1), M.A.T. Marques(1), L. Carvalho(2), M.L. Teixeira(3), M.F. Botelho(4), C. Robalo Cordeiro(1), M.C. Loureiro(1), A. Pégo(1), D.C. Telo De Morais(3), A.J.A. Robalo Cordeiro(1)
(1) Serviço de Pneumologia dos Hospitais da Uníversidade de Coimbra
(2) Serviço de Anatomia Patológica dos Hospitais da Universidade de Coimbra
(3) Serviço de Imagiologia dos Hospitais da Universidade de Coimbra
(4) Serviço de Biofisica da Faculdade de Medicina de Coimbra
This item has received

Under a Creative Commons license
Article information
RESUMO

Na sequência da definição de Nódulo Pulmonar Solitário (NPS) os autores analisam a sua etiologia, salientando neste contexto os condicionalismos epidemiológicos que a influenciam, assim como a importância assumida pelas lesões tumorais infecciosas, micóticas e parasitárias nas diferentes séries publicadas.

Seguidamente, abordam a estratégia diagnóstica desta situação clínica, com especial destaque para os exames clínico-radiológico, tomodensitométrico, broncofibroscópico e cito-histopatológico.

Em relação às semiologias clínico-radiológica e tomodensitométrica, salientam os critérios utilizados na determinação da natureza benigna ou maligna das lesões.

Quanto ao estudo cito-histopatológico, chamam a ateoção para a importância do material recolhido por broncofibroscopia e para a elevada rendabilidade foroecida pela punção aspirativa transtorácica.

No decurso da exposição são pontualmente apresentados os resultados de um estudo retrospectivo efectuado com os elementos recolhidos dos processos clínicos, hospitalares e extra-hospitalares, de 72 indivíduos operados por NPS.

No âmbito desta avaliação deram um especial relevo aos resultados fornecidos pela tomodensitometria (nas suas vertentes qualitativa e quantitativa) e pela punção aspirativa transtorácica e, ainda, a relação de alguns parâmetros (hábitos tabágicos, idade, dimensões, estabilidade lesional e calcificação) com a natureza benigna ou maligna das respectivas formações nodulares.

Finalmente, tecem algumas considerações sobre as opções terapêuticas destas lesões, as quais, para além das situações que apenas requerem tratamento médico, oscilam entre uma cuidadosa vigilância e a intervenção cirúrgica mais ou menos alargada.

Palavras-chave:
Nódulo Pulmonar Solitário
Broncofibroscopia
Tomografia Axial Computorizada
Punção Aspirativa Transtorácica
SUMMARY

Solitary Lung Nodule. Diagnostic strategies

In sequence of the definition of a Solitary Lung Nodule (SLN) the authors referred to its etiology underlining in this context the influence of the epidemiology and the role played by tumour lesions, infections both mycotic and parasitic, in the various series published.

Following this, referal to the diagnostic strategy directed at this clinical situations, with special attention to the clinical, radiological, tomodensitometric, bronchofibroscopy and citological histopathology has made.

In relation to the clinical, radiological and tomodensitometric semiology, the criteria used in determining the benign or malignant nature of the lesions are underlined.

ln the case of the cito-histological studies, attention was drawn to the significance of the material recovered with the bronchofibroscopy and the high rentability furnished by transthoracic aspirating puncture.

Along the exposition, the results of a retrospective study were presented one by one of all the elements recovered from the hospital non hospitalar clinical files of the operated 72 SLN.

In the ambit of this study special attention was given to the results furnished by the tomodensitometry (both quantitatively and qualitatively) and the result of the transthoracic aspirative puncture and also the relation of some parameters (smoking habits, age, dimensions, lesion stability and calcifications) of the respective nodular formations with a benign or malignant nature.

Finally, the authors refered to the treatement strategy of the lesions which besides from situations that only require medical treatemeot also may require careful vigilance and more or less widened surgical intervention.

Key-words:
Solitary Lung Nodule
Bronchofibroscopy
CT-Scan
Transthoracic Aspirating Puncture
Full text is only aviable in PDF
BIBLIOGRAFIA
[1.]
C. Demay, R. Piereon.
Le problémc des images rondes intra-pulmonaires solitaires.
Vie méd, 48 (1967), pp. 429-446
[2.]
Ch. Haas, F.X. Elebras, P. Choubrac.
Les opacites rondes solitaires intrapulmonaires Conduite diagnostiques et therapeutiques.
Poumon et Coeur, 5 (1977), pp. 315-318
[3.]
R. Israel-Asselain, J. Chebat.
Les foyer ronds isolés du parenchyme pulmonaire Problemes diagnostiques et therapeutiques.
Gaz Med. France, 73 (1966), pp. 4161-4168
[4.]
S. Marcianos, M.M. Movelhi, Ph. Grienier.
Diagnostic des opacites rondes pulmonaires.
EMC, (1987), pp. 1-11
[5.]
S. Lange.
Consulta, (1990), pp. 235-244
[6.]
J.D. Steele.
The solitary pulmonary nodule. Report of a cooperative study of resected asymptomatic solitary pulmonary nodules in males.
J. Thor Cardiovasc Surg, 46 (1963), pp. 21-39
[7.]
G. Trunk, D.R. Gracey, R.B. Byrd.
The management and evaluatton of the solitary pulmonary nodule.
Chest, 3 (1974), pp. 236-239
[8.]
R.R. Taylor, L.N. Rivkin, J.M. Salver.
The solitary pulmonary nodule:. A review of 236 consecutive cases.
1944 to 1956 Annaes Surg, 147 (1958), pp. 197-202
[9.]
B.R. Walske.
The solitary pulmonary nodule. A review of 213 cases.
Dis Chest, 49 (1966), pp. 302-304
[10.]
K.M. Moser.
Solitary pulmonary nodule.
JAMA., 227 (1974), pp. 1167-1168
[11.]
G.A. Lillington.
The solilary pulmonary nodule.
Am Rev. Resp Dis, 110 (1974), pp. 699-707
[12.]
G.A. Higgins, T.W. Shields, R.J. Keehn.
The solitary pulmonary nodule Ten-year follow-up of Veterans Administration Armed Forces Cooperative study.
Arch Surg., 110 (1975), pp. 570-575
[13.]
M.T.M. Godinho, L.L. Noronha, E. Moreira, Cama Raja.
Nódulo Solitário do pulmão. Experiência pessoal. A proposito de 250 casos operados.
Arq Soc Port Pat Resp, 2 (1990), pp. 113-125
[14.]
S.S. Siegelman, E.N. Zerhouni, F.P. Leo, N.F. Khouri, F.P. Stitik.
CT of solitary pulmonary nodule.
ARJ., 135 (1980), pp. 1-13
[15.]
S.S. Siegelman, N.F. Khouri, F.P. Leo, E.K. Fishman, R.M. Braverman, E.N. Zerhouni.
Solilary pulmonary nodule: CT assessement.
Radiology, 160 (1986), pp. 307-312
[16.]
N.F. Khouri, M.A. Meziane, E.N. Zerhouni, E.K. Fishman, S.S. Siegelman.
The solitary pulmonarynodule.
Chest., 91 (1987), pp. 128-133
[17.]
H. Abeles, A.D. Chaves.
The significance of calcification in pulmonary coin lesions.
Radiology., 58 (1952), pp. 199-202
[18.]
M.H. Nathan, V.P. Collins, R.A. Adams.
Diferentiation of benign and malignant pulmonary nodules by growth rate.
Radiology., 79 (1962), pp. 221-231
[19.]
M.H. Nathan.
Management of solitary pulmonary nodules - an organized aproach based on growth rates and statistics.
JAMA, 227 (1974), pp. 1141-1144
[20.]
J.A. Meyer.
Growth rate versus prognosis in resected primary bronchogenic carcinomas.
Cancer, 31 (1973), pp. 1468-1472
[21.]
M.S. Goldstein, M. Rush, P. Johnsen, C.L. Sprung.
Calcified adenocarcinoma of the lung with very high CT numbers.
Radiology., 150 (1984), pp. 785-786
[22.]
W.J. Fulkerson.
Current concepts: fiberoptic bronchoscopy.
N. Engl. J. Med., 311 (1984), pp. 511-516
[23.]
J.J.R. Proppovich, P.A. Kvale, M.S. Erichenhorn, J.R. Radke, J.M. Ohorodnik, G. Fine.
Diagnostic accuracy of multiple biopsies from flexible fiberoptic bronchoscopy: a comparison of central versus peripheral carcinoma.
Am Rev. Resp- Dis, 125 (1982), pp. 521-523
[24.]
D.A. Cortese, J.C. McDougall.
Biopsy and brushing of peripheral lung cancer with fluoroscopic guidance.
Chest., 75 (1979), pp. 141-145
[25.]
D.P. Naidich, R. Sussman, W.L. Kutcher, C.P. Aranda, S.M. Garay, N.A. Etenger.
Solitary pulmonary nodules CT - Bronchoscopic corelation.
Chest, 93 (1988), pp. 595-598
[26.]
J.M. Wallace, A.L. Deutsch.
Flexible fiberoptic bronchoscopy and percutaneous needle lung aspiration for evaluation the solitary pulmonary nodule.
Chest., 81 (1982), pp. 665-671
[27.]
J. Struyven, P.A. Gevenois, A. Cornil.
Tomodensitometrie du thorax.
EMC, 6000D (1991), pp. 11-13
[28.]
J.D. Godwin, J.M. Speckman, E.K. Fram.
Distinguishing benign from malignant pulmonary nodules by computed tomography.
Radiology., 144 (1982), pp. 349-351
[29.]
S.S. Sagel.
The solitary pulmonary nodule: role of CT.
AJR., 147 (1986), pp. 26-27
[30.]
E.A. Zerhouni, M. Boukadoum, M.A. Siddiki.
A standard phantom for quantitative CT analysis of pulmonary nodules.
Radiology., 149 (1983), pp. 767-773
[31.]
E.A. Zerhouni, J.F. Spivey, R.H. Morgan, F.P. Leo, F.P. Stitik, S.S. Sielgelman.
Quantitative CT measurements or solitary pulmonary nodules.
J. Comput. Assist. Tomogr., 6 (1982), pp. 1075-1087
[32.]
A.V. Proto, S.E. Thomas.
Pulmonary nodules studied by computed tomography.
Radiology., 156 (1985), pp. 149-153
[33.]
E.A. Zerhouni, J.F. Spivey, R.H. Morgan, F.P. Leo, F.P. Stitik, S.S. Silgelman.
Factors influencing quantitative CT measurements of solitary pulmonary nodules.
J Comput. Assist. Tomogr., 6 (1982), pp. 1075-1087
[34.]
J.J.P. Lima, A.M.S. Pereira, J.A.S. Rafael, M.F. Botelho.
Novos métodos de avaliação dos caudais sanguíneos colatera1s pulmonares em medicina nuclear.
Arq. Soc. Port. Pat. Resp., 2 (1989), pp. 105-130
[35.]
A.J.A. Robalo Cordeiro.
Atelectasia redonda.
Via Pneumológica, 1 (1988), pp. 67-71
[36.]
S.S. Sielgelmann, N.F. Khouri, W.W. Scott Jr., F.P. Leo, V.M. Hamper, E.K. Fishman.
CT of pulmonary hamartomas. Presented at the 84 th Annual Meeting of the American Roentgen Ray Societi.
Las Vegas, (1984),
[37.]
K. Ledor, B. Fish, L. Chaise, S. Ledor.
CT diagnosis of pulmonary hamartomas.
CT., 5 (1981), pp. 343-344
[38.]
J.H. Stanley, G.D. Fish, Andriole.
Lung lesions cytologic diagnosis by fine-needle biopsy.
Radiology., 162 (1987), pp. 389-391
[39.]
M.S. Levine, J.M. Weiss, L.H. Harrell, T.J. Cameron, K.M. Moser.
Transthoracic needle aspiration biopsy following negative fiberoptic bronchoscopy in solitary pulmonary nodules.
Chest, 6 (1988), pp. 1152-1155
[40.]
J.V. Zelch, A.F. Lalli, L.J. McCormack.
Aspiration biopsy in diagnosis of pulmonary nodule.
Chest, 63 (1973), pp. 149-152
[41.]
R.S. Fontana, W.E. Miller, J.W. Beabout.
Transthoracic needle aspirations of pulmonary lesions.
Med. Clin North. Am, 54 (1970), pp. 961-970
[42.]
R.P. Michel, A. Lushpihan, M.N. Ahmed.
Pathologic findings of transthoracic needle aspiration in the diagnosis of localized pulmonary lesions.
Cancer., 51 (1983), pp. 1663-1672
[43.]
R.H. Poe, R.E. Tobin.
Sensitivity and specificity of needle biopsy in lung malignancy.
Am. Rev. Resp. Dis., 12 (1980), pp. 725-728
[44.]
O.M. Stevenns, J.F. Weigen, G.A. Lillington.
Needle aspiration biopsy of localized pulmonary lesions with amplified fluoroscopic guidancc.
Am J Roentgenol. Radium Ther Nucl. Med., 103 (1968), pp. 561-575
[45.]
R.H. Cohan, G.G.E. Newman, S.D. Braun, Dunnick.
CT assistance for fluoroscopically guided transthoracic needle aspiration biopsy.
J. Comput. Assist. Tomogr., 8 (1984), pp. 1093-1098
[46.]
J.P. Senac, J. Giron.
Ponction-biopsie guidee par TDM en pathologic thoracique.
pp. 507-528
[47.]
E. Van Sounenberg, G. Casola, M. Ho.
Difficult thoracic lesions: CT guided biopsy experience in 150 cases.
Radiology, 167 (1988), pp. 457-461
[48.]
G. Dongay, M. Levade, J. Trocard, D. Lauque, P. Leophonte, P. Carles.
Ponction thoracique dirigée sous tomodensitométrie.
Rev. Pneumol. Clin., 42 (1986), pp. 63-68
[49.]
I. Fink, G. Gamsu, L.P. Harter.
CT guided aspiration biopsy of the thorax.
J Comput. Assist. Tomogr., 6 (1982), pp. 958-962
[50.]
W.N. Sinner.
Complications of percutaneous transthoracic needle aspiration biopsy.
Acta Radiologica Diagnosis., 17 (1976), pp. 813-828
[51.]
T.H. Berquist, P.B. Bailey, D.A. Cortese, W.E. Miller.
Transthoracic needle biopsy accuracy and complications in relation to location and type of lesion.
Mayo Clin. Proc., 55 (1980), pp. 475-481
[52.]
G.A. Lillington, G.M. Stevs.
The solitary nodule The other side of the coin.
Chest., 70 (1976), pp. 322-323
[53.]
S.R. Cummings, G.A. Lillington, R.J. Richard.
Managing solitary pulmonary nodules. The choice of strategy is a “close call”.
Am Rev. Resp. Dis, 134 (1986), pp. 453-460
[54.]
D.A. Cortese.
Solitary pulmonary nodule-observe, operate or what’?.
Chest., 81 (1982), pp. 662-663
Copyright © 1995. Sociedade Portuguesa de Pneumologia/SPP
Pulmonology
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?