Serial CTLS examinations revealing resolving LR 3 lesion and development of an LR 4A lesion

From left to right are three low-dose CTLS examinations each 6 months apart in the same patient, focused on the RUL in the top row and the LUL on the bottom row. The initial examination demonstrates a 6 to 7 mm LUL nodule (LR 3) for which a 6 month follow-up CTLS examination was obtained (D); there were no nodules in the right lung on baseline exam (A). At 6 months, there is a reassuring decrease in the solid nature of the LUL nodule (E); however, a new 4 to 5 mm nodule in the RUL has developed (B). As the new RUL nodule is between 4 and 6 mm it qualifies as LR 3 with another 6 month follow-up recommendation. The images on the far right from this 6 month follow-up (ie, a total of 12 months from the baseline exam) show near resolution of the LUL nodule (F) and growth of the RUL nodule which has become spiculated and measures 7 to 8 mm (C). Despite small size of this nodule, due to growth, the exam was classified as a LR 4A. Bronchoscopic RUL biopsy identified an early stage squamous cell carcinoma.