Clinical and imaging evaluation of the solitary pulmonary nodule

Management of a solitary pulmonary nodule remains a common clinical problem. The main goal of management is to choose a diagnostic and therapeutic scheme that is appropriately matched to the patient's clinical risk of malignancy. Clinical risk can be estimated from consideration of data on the overall prevalence of malignancy in solitary pulmonary nodules in various populations, the size of the pulmonary nodule, the patient's age and the patient's history of smoking. Nodules that have not grown for at least two years and those that are calcified are usually benign and require no further work-up. Suspicious nodules require further evaluation. The approach for patients at low clinical risk for malignancy may be clinical and radiographic observation, while that for patients at moderate to high risk for malignancy may be needle biopsy or thoracotomy. Whenever possible, the patient should be encouraged to participate in the decision-making process concerning the management of this clinical problem.