The incidental pulmonary nodule in a child
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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.
KeywordsChest Computed tomography Fleischner criteria Pediatric Incidental findings Lung Lung cancer Lung nodule
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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