Radiological Clarification Of Pulmo

Solitary pulmonary nodules (SPN) are a frequent diagnostic problem in the clinical routine. The main aim of the management of patients with SPNs is to differentiate malignant from benign nodules with a high level of confidence. Knowledge of the pretest probability of malignancy is essential. Recently, the radiological morphology has been expanded to differentiate solid, semi-solid and ground glass nodules by the density in computed tomography (CT). In addition, diagnostic algorithms are well established for small SPNs <= 8 mm and normal sized SPNs > 8 mm in diameter. For normal SPNs the presence of homogeneous calcification and lack of growth are highly suggestive of a benign lesion. For the indeterminate small SPNs CT follow-up is recommended, at time intervals depending on the size, pretest probability for malignancy and CT morphology. Calculation of tumor doubling times with CT-based 3D volumetry of SPNs has recently been included in the clinical routine. For the indeterminate SPNs > 8 mm the management should be based on the pretest probability for malignancy, with CT follow-up, functional imaging, guided biopsy for fine tissue diagnostics and possibly surgical removal as diagnostic options.