Date:
Patient:
Reason for Visit:
Follow-up for pulmonary nodule(s)
Evaluation of new or existing nodule(s) on chest imaging
Assessment for malignancy risk
History:
Present Illness:
Date of initial detection of pulmonary nodule(s)
Size, location, and number of nodules on current imaging
Presence of any concerning symptoms (e.g., cough, hemoptysis, chest pain, weight loss)
Smoking history (important risk factor for lung cancer)
Past Medical History (PMH):
Prior history of lung cancer or other lung diseases (e.g., COPD, tuberculosis)
Personal or family history of malignancy
Social History:
Smoking history (pack-years) – crucial for malignancy risk assessment
Occupational exposures to carcinogens (e.g., asbestos, radon)
Physical Exam:
Vital Signs: Assess for fever or other signs of infection.
General: Look for signs of weight loss or other concerning symptoms.
Pulmonary: Normal auscultation unless there are co-existing lung conditions.
Diagnostic Tests (may be ordered depending on clinical presentation and nodule characteristics):
Chest X-ray (may be available from initial detection): Provides basic information about nodule size and location.
Chest CT scan: More detailed imaging for nodule size, location, and features suggestive of malignancy (e.g., spiculation, lobulation).
PET scan (may be used in specific situations): Can help differentiate benign from malignant nodules based on increased metabolic activity in cancer cells.
Sputum cytology (if cough productive): Microscopic examination of coughed-up mucus to look for abnormal cells.
Bronchoscopy with transbronchial biopsy: Direct visualization of the airways and potential biopsy of the nodule for tissue diagnosis.
Assessment:
Nodule characteristics: Size, location, CT features (attenuation, margins, calcification).
Malignancy risk: Based on clinical factors (age, smoking history) and nodule characteristics. Risk stratification tools like the American College of Chest Physicians (ACCP) Fleischner Society guidelines may be used.
Need for further workup: Consider risk factors and imaging findings to determine if additional tests are necessary for diagnosis.
Plan:
Management plan based on malignancy risk and patient factors:
Observation: For low-risk nodules with scheduled follow-up imaging at appropriate intervals.
Minimally invasive biopsy: Techniques like transthoracic needle aspiration (TTNA) or core needle biopsy for nodules with intermediate malignancy risk.
Bronchoscopy with biopsy: For nodules with features suspicious for malignancy or those inaccessible with percutaneous techniques.
Surgical resection: May be considered for high-risk nodules or those with positive biopsy results.
Referral to a pulmonologist or thoracic surgeon: For complex cases, high-risk nodules, or consideration of surgical intervention.
Patient education: Provide information about pulmonary nodules, the rationale for chosen management approach, potential risks and benefits of procedures, and the importance of follow-up.
Smoking cessation counseling should be offered to all smokers.
Follow-up:
Schedule for follow-up appointments based on the management plan:
Close observation with repeat imaging for low-risk nodules.
Earlier follow-up with imaging or biopsy for nodules with intermediate risk.
Discuss ongoing management plan after definitive diagnosis (benign vs. malignant).
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of pulmonary nodules