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The incidental pulmonary nodule in a child

Part 2: Commentary and suggestions for clinical management, risk communication and prevention

Pediatric Radiology volume 45, pages 634–639 (2015)Cite this article

Abstract

The incidental detection of small lung nodules in children is a vexing consequence of an increased reliance on CT. We present an algorithm for the management of lung nodules detected on CT in children, based on the presence or absence of symptoms, the presence or absence of elements in the clinical history that might explain these nodules, and the imaging characteristics of the nodules (such as attenuation measurements within the nodule). We provide suggestions on how to perform a thoughtfully directed and focused search for clinically occult extrathoracic disease processes (including malignant disease) that may present as an incidentally detected lung nodule on CT. This algorithm emphasizes that because of the lack of definitive information on the natural history of small solid nodules that are truly detected incidentally, their clinical management is highly dependent on the caregivers’ individual risk tolerance. In addition, we present strategies to reduce the prevalence of these incidental findings, by preventing unnecessary chest CT scans or inadvertent inclusion of portions of the lungs in scans of adjacent body parts. Application of these guidelines provides pediatric radiologists with an important opportunity to practice patient-centered and evidence-based medicine.

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Acknowledgments

Although all authors are members of the Society for Pediatric Radiology (SPR) Thoracic Imaging Committee, the opinions expressed here are solely those of the authors and are not endorsed by the SPR.

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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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, Medical University of South Carolina, Charleston, SC, USA

    Paul G. Thacker

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

    Daniel J. Podberesky

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

    Edward Y. Lee

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

    Ramesh S. Iyer

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

    Shilpa V. Hegde

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

    R. Paul Guillerman

  8. 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

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

Correspondence to Sjirk J. Westra.

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Westra, S.J., Thacker, P.G., Podberesky, D.J. et al. The incidental pulmonary nodule in a child. Pediatr Radiol 45, 634–639 (2015). https://doi.org/10.1007/s00247-014-3269-5

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  • DOI: https://doi.org/10.1007/s00247-014-3269-5

Keywords

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