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Pediatric Radiology

, Volume 45, Issue 5, pp 634–639 | Cite as

The incidental pulmonary nodule in a child

Part 2: Commentary and suggestions for clinical management, risk communication and prevention
  • Sjirk J. WestraEmail author
  • Paul G. Thacker
  • Daniel J. Podberesky
  • Edward Y. Lee
  • Ramesh S. Iyer
  • Shilpa V. Hegde
  • R. Paul Guillerman
  • Maryam Ghadimi Mahani
Review

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.

Keywords

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

Notes

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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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Sjirk J. Westra
    • 1
    Email author
  • Paul G. Thacker
    • 2
  • Daniel J. Podberesky
    • 3
  • Edward Y. Lee
    • 4
  • Ramesh S. Iyer
    • 5
  • Shilpa V. Hegde
    • 6
  • R. Paul Guillerman
    • 7
  • Maryam Ghadimi Mahani
    • 8
  1. 1.Division of Pediatric RadiologyMassachusetts General HospitalBostonUSA
  2. 2.Department of RadiologyMedical University of South CarolinaCharlestonUSA
  3. 3.Department of RadiologyNemours Children’s HospitalOrlandoUSA
  4. 4.Department of Pediatric RadiologyBoston Children’s HospitalBostonUSA
  5. 5.Department of RadiologySeattle Children’s HospitalSeattleUSA
  6. 6.Department of RadiologyArkansas Children’s HospitalLittle RockUSA
  7. 7.Department of RadiologyTexas Children’s HospitalHoustonUSA
  8. 8.Section of Pediatric Radiology, C. S. Mott Children’s Hospital, Department of RadiologyUniversity of Michigan Health SystemAnn ArborUSA

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