[Incidental pulmonary nodules on CT imaging: what to do?]

Incidental pulmonary nodules are very frequently found on CT imaging and may represent (early stage) lung cancers without any signs or symptoms. These incidental findings can be solid lesions or ground glass lesions that may be solitary or multiple. Careful, and systematic evaluation of these findings in imaging is needed to determine the risk of malignancy, based on imaging characteristics, patient factors like smoking habits, prior cancers or family history, and growth rate preferably determined by volume measurements. Once the risk of malignancy is increased, minimal invasive image guided biopsy is warranted, preferably by navigation bronchoscopy. We present two cases to illustrate this clinical workup: one case with a benign solitary pulmonary nodule, and a second case with multiple ground glass opacities, diagnosed as synchronous primary adenocarcinomas of the lung. This is followed by a review of the current status of computer and artificial intelligence aided diagnostic support and clinical workflow optimization.