The incidental pulmonary nodule in a child Part 1: recommendations from the SPR Thoracic Imaging Committee regarding characterization, significance and follow-up

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 groundglass 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 S. J. Westra (*) Division of Pediatric Radiology, Massachusetts General Hospital, 34 Fruit St., White 246A, Boston, MA 02114, USA e-mail: [email protected] A. S. Brody Department of Radiology (CH-1), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA M. G. Mahani Section of Pediatric Radiology, C. S. Mott Children’s Hospital Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA R. P. Guillerman Department of Radiology, Texas Children’s Hospital, Houston, TX, USA S. V. Hegde Department of Radiology, Arkansas Children’s Hospital, Little Rock, AR, USA R. S. Iyer Department of Radiology, Seattle Children’s Hospital, Seattle, WA, USA E. Y. Lee Department of Pediatric Radiology, Boston Children’s Hospital, Boston, MA, USA B. Newman Department of Radiology, Lucile Packard Children’s Hospital at Stanford University, Stanford, CA, USA D. J. Podberesky Department of Radiology, Nemours Children’s Hospital, Orlando, FL, USA P. G. Thacker Department of Radiology, Medical University of South Carolina, Charleston, SC, USA Pediatr Radiol DOI 10.1007/s00247-014-3267-7