A 42-year-old man has a solitary “coin lesion” 2 cm in diameter in the area of the right upper lobe on a routine chest radiograph. Which of the following is/are true?

b. If a CT scan shows mediastinal adenopathy, mediastinoscopy is preferable to thoracotomy

d. Calcification in a concentric or “popcorn” configuration denotes a benign lesion

In the evaluation of a solitary lung lesion, previous radiographs are important, particularly if the lesion is new. A coin lesion that is growing slowly does not necessarily indicate malignancy, since the most common benign tumor, hamartoma, has a variable pattern of slow growth and typically will show “popcorn” calcification. Concentric calcification is also most suggestive of a benign granuloma. In the absence of previous radiographs, the lesion must be assumed to be malignant until proved otherwise and should not be dismissed to follow-up. If a CT scan shows mediastinal adenopathy, then mediastinoscopy with biopsy is appropriate to make a diagnosis. Needle aspiration results of “chronic inflammatory cells” is non-diagnostic.