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The incidental pulmonary nodule in a child

Part 1: recommendations from the SPR Thoracic Imaging Committee regarding characterization, significance and follow-up

Pediatric Radiology volume 45, pages 628–633 (2015)Cite this article

Abstract

No guidelines are in place for the follow-up and management of pulmonary nodules that are incidentally detected on CT in the pediatric population. The Fleischner guidelines, which were developed for the older adult population, do not apply to children. This review summarizes the evidence collected by the Society for Pediatric Radiology (SPR) Thoracic Imaging Committee in its attempt to develop pediatric-specific guidelines.

Small pulmonary opacities can be characterized as linear or as ground-glass or solid nodules. Linear opacities and ground-glass nodules are extremely unlikely to represent an early primary or metastatic malignancy in a child. In our review, we found a virtual absence of reported cases of a primary pulmonary malignancy presenting as an incidentally detected small lung nodule on CT in a healthy immune-competent child.

Because of the lack of definitive information on the clinical significance of small lung nodules that are incidentally detected on CT in children, the management of those that do not have the typical characteristics of an intrapulmonary lymph node should be dictated by the clinical history as to possible exposure to infectious agents, the presence of an occult immunodeficiency, the much higher likelihood that the nodule represents a metastasis than a primary lung tumor, and ultimately the individual preference of the child’s caregiver. Nodules appearing in children with a history of immune deficiency, malignancy or congenital pulmonary airway malformation should not be considered incidental, and their workup should be dictated by the natural history of these underlying conditions.

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Conflicts of interest

Dr. Podberesky discloses the following relationships: Toshiba of America Medical Systems (speaker’s bureau), GE Healthcare, Philips Healthcare and Siemens Healthcare (travel reimbursement), Guerbet (consultant), Amirsys (chapter royalties).

Author information

Affiliations

  1. Division of Pediatric Radiology, Massachusetts General Hospital, 34 Fruit St., White 246A, Boston, MA, 02114, USA

    Sjirk J. Westra

  2. Department of Radiology (CH-1), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Alan S. Brody

  3. Section of Pediatric Radiology, C. S. Mott Children’s Hospital Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA

    Maryam Ghadimi Mahani

  4. Department of Radiology, Texas Children’s Hospital, Houston, TX, USA

    R. Paul Guillerman

  5. Department of Radiology, Arkansas Children’s Hospital, Little Rock, AR, USA

    Shilpa V. Hegde

  6. Department of Radiology, Seattle Children’s Hospital, Seattle, WA, USA

    Ramesh S. Iyer

  7. Department of Pediatric Radiology, Boston Children’s Hospital, Boston, MA, USA

    Edward Y. Lee

  8. Department of Radiology, Lucile Packard Children’s Hospital at Stanford University, Stanford, CA, USA

    Beverley Newman

  9. Department of Radiology, Nemours Children’s Hospital, Orlando, FL, USA

    Daniel J. Podberesky

  10. Department of Radiology, Medical University of South Carolina, Charleston, SC, USA

    Paul G. Thacker

Authors
  1. Sjirk J. Westra
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  2. Alan S. Brody
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  3. Maryam Ghadimi Mahani
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  4. R. Paul Guillerman
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  5. Shilpa V. Hegde
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  6. Ramesh S. Iyer
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  7. Edward Y. Lee
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  8. Beverley Newman
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  9. Daniel J. Podberesky
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  10. Paul G. Thacker
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Corresponding author

Correspondence to Sjirk J. Westra.

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Westra, S.J., Brody, A.S., Mahani, M.G. et al. The incidental pulmonary nodule in a child. Pediatr Radiol 45, 628–633 (2015). https://doi.org/10.1007/s00247-014-3267-7

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  • DOI: https://doi.org/10.1007/s00247-014-3267-7

Keywords

  • Chest
  • Computed tomography
  • Fleischner criteria
  • Pediatric
  • Incidental findings
  • Lung
  • Lung cancer
  • Lung nodule