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Chronic pulmonary aspergillosis — SCE Respiratory MCQ

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HardRespiratory InfectionsChronic pulmonary aspergillosisSCE Respiratory

A persistent 14 mm part-solid pulmonary nodule has an enlarging solid component, increasing from 3 mm to 6 mm over 12 months. The patient is fit for treatment and staging shows no spread. What is the preferred direction of management?

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Correct answer: D — Proceed to definitive treatment after individualised risk assessment

Growth of the solid component in a persistent part-solid nodule is a strong marker of invasive malignancy even if overall diameter changes little. BTS guidance advises favouring resection or other definitive treatment over continued observation when the solid component enlarges, after considering comorbidity, patient preference and procedural risk in the MDT.

Reference: BTS guideline for investigation and management of pulmonary nodules (Published 2015): https://thorax.bmj.com/content/70/Suppl_2/ii1; BTS pulmonary-nodule guideline resources (Published 2015; current BTS resource): https://www.brit-thoracic.org.uk/quality-improvement/guidelines/pulmonary-nodules/