Pediatric Radiology

, Volume 45, Issue 5, pp 628–633 | Cite as

The incidental pulmonary nodule in a child

Part 1: recommendations from the SPR Thoracic Imaging Committee regarding characterization, significance and follow-up
  • Sjirk J. WestraEmail author
  • Alan S. Brody
  • Maryam Ghadimi Mahani
  • R. Paul Guillerman
  • Shilpa V. Hegde
  • Ramesh S. Iyer
  • Edward Y. Lee
  • Beverley Newman
  • Daniel J. Podberesky
  • Paul G. Thacker


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.


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


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).


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Sjirk J. Westra
    • 1
    Email author
  • Alan S. Brody
    • 2
  • Maryam Ghadimi Mahani
    • 3
  • R. Paul Guillerman
    • 4
  • Shilpa V. Hegde
    • 5
  • Ramesh S. Iyer
    • 6
  • Edward Y. Lee
    • 7
  • Beverley Newman
    • 8
  • Daniel J. Podberesky
    • 9
  • Paul G. Thacker
    • 10
  1. 1.Division of Pediatric RadiologyMassachusetts General HospitalBostonUSA
  2. 2.Department of Radiology (CH-1)Cincinnati Children’s Hospital Medical CenterCincinnatiUSA
  3. 3.Section of Pediatric Radiology, C. S. Mott Children’s Hospital Department of RadiologyUniversity of Michigan Health SystemAnn ArborUSA
  4. 4.Department of RadiologyTexas Children’s HospitalHoustonUSA
  5. 5.Department of RadiologyArkansas Children’s HospitalLittle RockUSA
  6. 6.Department of RadiologySeattle Children’s HospitalSeattleUSA
  7. 7.Department of Pediatric RadiologyBoston Children’s HospitalBostonUSA
  8. 8.Department of RadiologyLucile Packard Children’s Hospital at Stanford UniversityStanfordUSA
  9. 9.Department of RadiologyNemours Children’s HospitalOrlandoUSA
  10. 10.Department of RadiologyMedical University of South CarolinaCharlestonUSA

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