LearningRadiology - Solitary Pulmonary Nodule

The Solitary Pulmonary Nodule

An Approach

Although a large part of the evaluation of a solitary pulmonary nodule (SPN) relies on radiology, the important decisions are made by the patient’s physician and by the patient himself. It is often the patient who decides between follow-up or surgery.

• Dividing patients in to five groups

1. The patient’s clinical course clearly shows the nodule is benign

• Relatively rare

• Nodule forms during resolution of a pneumonia, pulmonary infarct or pulmonary hematoma

No further management necessary

2. The nodule is benign by virtue of calcification demonstrated by

• Plain films

• CT scan

• Conventional tomography

Manage with a few follow-up chest x-rays at 6-12 months for stability

3. The nodule is uncalcified but stable for two years on serial films

• Almost always benign

Manage with a few follow-up chest x-rays at 6-12 months for stability

4. The nodule is uncalcified and growing, or

There are no previous radiographs for comparison

• Large group of patients

• Further divided into

• Non-operable patients for other reasons

No further management necessary

• Patients at low risk for malignancy–under 30 with no smoking history

Manage with serial radiographs or biopsy

• Patients at risk for cancer

• Includes middle-aged or older smokers

Manage with biopsy, not with serial radiographs

5. The lesion is uncalcified and there is an extrapulmonary malignancy

• Such a nodule could be a solitary metastasis, a new primary or a benign nodule

Manage with biopsy; resection may be considered if no other lesions are demonstrated

WH/‘93