Sample, Sammy G ST0001

Intervention and Surgical Treatment Form 1234567890


Treatment

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Nodules

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(parenchymal and endobronchial)
Update the Nodule Status, Action, and Pathologic Diagnosis for each of the nodules affected by this procedure.
Enter any pathologic details given in the surgical pathology report in the Surgical Pathology Details field.
Update the Follow-up section.
If no nodules were detected, you may skip this section.

Emphysema/Coronary Calcifications




Other Abnormalities

RUL RML RLL LUL LLL

(focal - put in nodule grid)

(i.e. bronchial resection margin)

Early and Late Findings of Interstitial Lung Disease

RUL RML RLL LUL LLL

(calculated)

(report if ovoid > 7 mm or if thymic shape with width > 1.3cm)

Lymph Nodes (w/o central fat)

Any enlarged or growing hilar or mediastinal lymph nodes
(short axis > 10mm)
(any size for para-esophageal)
8 th edition classification: CHEST 2017; 151: 193-203
Any calcified hilar or mediastinal lymph nodes
Abnormal axillary lymph nodes
Other Vascular Abnormalities
Esophageal
Hiatal Hernia
Other Mediastinal Masses
Right Breast
Right Breast Density Classification (BI-RADS)
Left Breast
Left Breast Density Classification (BI-RADS)
Gallbladder
Spleen
Liver
Pancreas
Adrenals
Kidneys

Summary of interventions for this malignancy

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Follow Up



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