CT follow-up of a solitary pulmonary nodule: New recommendations
Finding a solitary pulmonary nodule on a chest x-ray is common and once detected, it needs to be evaluated promptly and managed because many such nodules can be malignant in nature. A large majority are picked up as asymptomatic lesions.
A solitary pulmonary nodule has been referred to as "coin" lesion, a nomenclature first devised by John Steel way back in the 60s. Some of its major characteristic features include solitary nature, circumscribed margins, diameter double the cross-sectional diameter of an adjacent blood vessel adjacent (1.5 cm), homogeneous density and completely surrounded by lung with no regional lymph node enlargement or satellite lesions.
There is a long list of conditions that are to be considered in the differential diagnosis of a solitary pulmonary nodule. The most common include lung cancer, benign lung tumor, tuberculoma, fungal granuloma, lung abscess and metastasis.
“Wait and Watch”, biopsy of the nodule or immediate thoracotomy are the management options. A thin slice CT (1 mm) is done to accurately describe the characteristics of the nodule and decision is taken on CT findings.
Dr KK Aggarwal
National President IMA & HCFI
