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Published on: May 19, 2023
Incidental pulmonary nodules in children: characteristic features and clinical course
Ayşen Başaran1, Abdurrahman Erdem Başaran1, Ayşe Keven2
1Division of Pulmonology, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey.
Insights
Pediatric incidental pulmonary nodules (IPN) often resolve or shrink, especially in younger children with subsolid nodules and mosaic attenuation. These factors aid in predicting nodule behavior on follow-up imaging.
Area of Science:
- Pediatric Pulmonology
- Radiology
- Thoracic Imaging
Background:
- Limited data exists on the natural progression of incidental pulmonary nodules (IPN) in children.
- Understanding IPN behavior is crucial for appropriate clinical management and follow-up strategies.
Purpose of the Study:
- To investigate the natural course of incidentally detected pulmonary nodules in pediatric patients.
- To identify characteristic features and predictive factors influencing the resolution or stability of these nodules.
Main Methods:
- Retrospective analysis of pediatric patients with pulmonary nodules identified via high-resolution computed tomography (HRCT).
- Patients were categorized based on nodule changes (decrease/disappearance vs. stability) on follow-up HRCT.
- Comparison of demographic data, nodule characteristics (size, density, calcification), and associated HRCT findings between groups.
Main Results:
- Of 177 nodules in 66 children, 12% showed size reduction or disappearance on follow-up (mean 16.3 months).
- Nodules that resolved or shrank were associated with younger patient age, subsolid density, and mosaic attenuation patterns.
- No malignancies were detected during a mean follow-up of 38.3 months.
Conclusions:
- Younger age, subsolid nodule composition, presence of calcification, and mosaic attenuation on HRCT are key factors in predicting nodule behavior.
- These findings can assist in estimating the follow-up course of incidental pulmonary nodules in children.
Background:
There exists insufficient information about the natural course of incidental pulmonary nodules (IPN) determined on tomography in children. The aim was to determine the characteristic features and factors affecting the course of IPN.
Methods:
This retrospective study included patients who presented at the Pediatric Pulmonology, Allergy & Immunology Section of Akdeniz University Hospital between January 2014-2020, and were determined with pulmonary nodules on high-resolution computed tomography (HRCT). The patients were separated into two groups as those with a nodule decreased in size or which had disappeared on the follow-up HRCT (Group 1) and those with a nodule which had remained at the same size (Group 2). These two groups were compared in respect to demographic data, nodule size and characteristics, and accompanying findings on HRCT.
Results:
A total of 177 nodules were determined in the 66 patients included in the study. A follow-up HRCT was taken within mean 16.29±11.38 months in 27 patients. In these patients, 78 nodules were determined on the initial HRCT. On the follow-up, twelve of the nodules were seen to have shrunk or disappeared compared to the initial images, 66 had remained the same size, and none had grown. The mean age of the patients in Group 1 was statistically significantly lower than that of patients in Group 2 (p < 0.001). The rates of an accompanying mosaic attenuation pattern (p < 0.001) on HRCT and subsolid density (p=0.011) of the nodules in Group 1 were statistically significantly higher compared to Group 2 and the rate of calcification content was statistically significantly lower (p=0.002). No suspicious or confirmed malignancy was observed in any case throughout the mean follow-up period of 38.33±16.5 months after the initial HRCT.
Conclusions:
The young age of patients, subsolid structure of nodules, calcification content and the presence of an accompanying mosaic attenuation pattern on HRCT, could be useful factors in the estimation of size in the follow-up of nodules.
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