Synopsis
Characterise focal lung and mediastinal abnormalities, distinguish an incidental nodule from suspected cancer or vascular emergency and create an owned CT, referral or tissue pathway.
- Describe a focal lung lesion by size, number, density, margin, calcification, cavitation, growth and relation to pleura, airway, hila and vessels; compare every useful prior study.
- A mass or chest radiograph suspicious for lung cancer enters an urgent cancer pathway; contrast-enhanced CT of chest, lower neck, liver and adrenals should precede biopsy planning.
- Mediastinal widening is non-specific and projection sensitive, yet radiography cannot exclude acute aortic injury: pursue urgent CT when symptoms, trauma or physiology make the diagnosis consequential.
Key red flags
A new spiculated mass, hilar enlargement, lobar collapse, pleural nodularity or destructive bone change requires prompt suspected-cancer action.
Mediastinal widening on a rotated AP portable radiograph may be technical, but compatible acute pain, trauma or shock still mandates definitive vascular imaging.
Haemoptysis, weight loss, persistent cough or recurrent same-site pneumonia increases concern even when a radiographic lesion is subtle.
A pulmonary nodule in a person under 18, with known cancer, immunosuppression or suspected infection does not fit routine adult incidental-nodule algorithms.
Any recommended surveillance scan needs a named owner and fail-safe system; an interval written in a report is not follow-up by itself.
Spiculation, hilar mass, bronchial cutoff, lobar collapse, persistent focal consolidation or nodal enlargement raises suspected lung cancer and prompts referral.
Tearing pain, trauma, pulse inequality, neurological deficit, hypotension or pleural blood with mediastinal change requires urgent contrast CT and specialist escalation.
Investigation priorities
Characterise a radiographic nodule or mass and define size, density, margins, growth, airways, nodes and pleura.
Management branches
A smoker with weight loss has a chest radiograph showing a new spiculated hilar mass and lobar collapse.
- Communicate the suspicious finding and enter the suspected lung-cancer pathway rather than arranging unowned routine follow-up.
- Obtain contrast-enhanced CT of chest, lower neck, liver and adrenals before biopsy to map tumour, nodes, metastases and a safe target.
A small pulmonary nodule is found incidentally on CT in an otherwise stable adult.