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Solitary Pulmonary Nodule
Diagnosis/Definition
A SPN is a rounded radiographic density of 2cm or less in diameter surrounded by pulmonary parenchyma and is often asymptomatic. As these lesions may represent early bronchogenic carcinoma, their timely management is important.
Initial Diagnosis and Management
- History; to include smoking, TB/fungal risks and occupational exposures.
- Physical exam
- Evaluation process for the chest radiograph (CXR): Search for old CXR’s for comparison with current film (this step often saves an unnecessary work-up)
- If lesion is stable in size for 2 or more years, or is clearly calcified in a benign pattern, the probability of malignancy is very low, and no further evaluation or follow-up is mandatory.
- If lesion is new or enlarging, prompt referral to Pulmonary Service is required for consideration of resection.
- If an insufficient radiographic history is available (> 1 but < 2 years), to make either of the above determinations, at a minimum, the lesion should be followed radiographically initially at 2-3 month intervals to assure stability until at least a 2 year time frame has been met.
Ongoing Management and Objectives
- To assure timely, consistent follow up of lesions of indeterminate etiology and/or age.
- Prompt referral for further evaluation and management of lesions that are progressive or new.
Indications for Specialty Care Referral
New or enlarging lesions.
Lesions of an indeterminate nature or age in which a high suspicion for malignancy exists. Risk factors include: Increasing age (especially > 40 years); Prior smoking history > 20 pack/years; Concurrent interstitial lung disease; Asbestos exposure.
Criteria for Return to Primary Care
Lesion determined to be benign or of sufficient stability over time as to not require further follow-up.
For patients in whom the lesion was resected, follow-up will be maintained in Pulmonary for varying lengths of time for this issue only. After release from Pulmonary in these cases, generally no special follow up is required.
