Bronchoscopy

Pulmonary Nodules

Nathan Hinkle — Sat, 12 Sep 2026 05:00:00 +0000

Date Added:

September 12, 2026

Journal/Publication:

The New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

September 2, 2026

Issue:

Volume:

395

Pages:

894-905

URL:

Pulmonary Nodules

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

DOI: 10.1056/NEJMcp2515063

Keywords

pulmonary nodules

breathing difficulties

adenomatous hyperplasia

MeSH

Bronchoscopy

biopsy

Neoplasms

RPR Commentary: A review of the evaluation and management of pulmonary nodules. James W. Mold, MD, MPH

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Pulmonary nodules are classified as solid or subsolid, with subsolid nodules further classified as part-solid or pure ground-glass. Management strategies differ according to the type of nodule. A comparison of current and previous imaging studies, when available, is essential to assess the risk of the nodule being malignant. Solid nodules that have been stable for 2 years are considered to be benign, whereas subsolid nodules require a longer period of stability to be considered benign. Prediction models to stratify the risk of the nodule being malignant can be used to guide the management of solid nodules. Computed tomographic (CT) surveillance is indicated for low-risk nodules; positron-emission tomography–CT, biopsy, or both for intermediate-risk nodules; and surgical resection for selected high-risk nodules. Subsolid nodules are often slower growing than solid nodules but are associated with a higher risk of being malignant, especially if a solid component develops or progressively enlarges. Biopsy methods include transthoracic needle biopsy and navigational bronchoscopy. Optimal overall management balances timely diagnosis in persons who have cancer with the avoidance of unnecessary invasive procedures in persons who have benign disease.

Author/s:

Matthew E.J. Callister, Gerard Silvestri

Tilt Table Testing

Alex Haga — Tue, 23 Apr 2024 17:41:24 +0000

Date Added:

April 23, 2024

Journal/Publication:

JAMA

Publisher:

JAMA

Publication Date:

April 11, 2024

URL:

Tilt Table Testing

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2024.0004

Keywords

Cardiac Catheterization

PMID (1):

38602671

MeSH

hydrocortisone

Methacholine Chloride

Cardiac Catheterization

A summary and example of how to use tilt table testing in patients with syncope and various other fairly common symptoms. James W. Mold, MD, MPH

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A 43-year-old woman presented with a 1-year history of recurring symptoms of sudden onset of fatigue, palpitations, dyspnea, chest pain, lightheadedness, and nausea that were associated with standing and resolved with sitting. These symptoms began 1 month after mild COVID-19 infection. At presentation, while supine, blood pressure (BP) was 123/70 mm Hg and heart rate (HR) was 90/min; while seated, BP was 120/80 and HR was 93/min; after standing for 1 minute, BP was 124/80 and HR was 119/min. Physical examination results were normal. Oxygen saturation was 98% at rest while breathing room air. She had no oxygen desaturation during a 6-minute walk test but walked only 282 m (45% predicted). Complete blood cell count, morning cortisol, and thyrotropin blood levels were normal. Electrocardiogram (ECG), chest computed tomography, pulmonary function testing, methacholine challenge, bronchoscopy, echocardiography, and cardiac catheterization findings were normal. During tilt table testing, the patient experienced lightheadedness and nausea when moved from horizontal to the upright position. Results of the tilt table test are shown in the Table and Figure.

Author/s:

Chesire, W.P., Dudenkov, D.V., Munipalli, B.