Pulmonary "Coin" Lesions

In the so-called "coin" lesion, a definitive confirmed diagnosis usually cannot be reached by the various laboratory and x-ray procedures (Aufses). The diagnosis requires surgical exploration, for the removal of the nodule (Effler) and pathological study (Long, Moersch, Weed and McDonald). When this is done, these lesions, many of which look similar on the x-ray film, will finally be diagnosed as a large variety of pathological entities.

The important fact, however, is that in various series from 15 to 30 per cent of the lesions are malignant, and in some specially selected older age groups as high as 70 per cent. Small flecks of calcium, not clearly part of a Ghon complex, do not rule out the possibility that the lesion may be malignant, and they are not a contraindication to exploratory procedures. Exploratory thoracotomy is a benign procedure comparable in risk to apppendectomy and should be thought of in the same way as most physicians and even the general public have been educated to think about biopsy of a lump in the breast. The nodule should be removed so that a definite pathological diagnosis can be made. It should not just be watched until a clinical diagnosis can be achieved because by that time metastases are likely to be present and the chance for successful surgery has been greatly reduced. Agreement on these points is almost universal among men skilled in treating diseases of the chest but is not as widespread among the general medical profession and certainly not among the general public. This is a subject, then, that needs continued emphasis.