Urgent considerations
See Differentials for more details
A solitary pulmonary nodule may first be detected following imaging of the chest, often with chest x-ray (CXR) or chest computed tomography (CT). A solitary pulmonary nodule is rarely, if ever, an emergency. However, prompt evaluation is important to: facilitate timely treatment of malignancy when present; or, allay patient concerns if the nodule is benign.
Chest CT is the preferred imaging modality to help assess and characterise the nodule, and will assist in determining the size/volume, density, location, edge characteristics, and pattern of calcification of the nodule.[12] Other abnormalities within the chest or the abdomen and pelvis (e.g., associated mediastinal or hilar lymphadenopathy, pleural effusions, extra-thoracic primary cancers) can also be identified.
The likelihood of malignancy can be estimated or calculated from the patient history (e.g., age, history of tobacco use, history of prior malignancy, family history of lung cancer, occupational exposures) and review of the radiological characteristics of the nodule. The diagnostic and therapeutic approach is guided by the likelihood of malignancy, in combination with factors such as the wishes of the patient and any pre-existing comorbidity.
The clinician should be aware that, left untreated, patients with even early stages of lung cancer have a poor survival rate. Thus, patients with suspected malignancy should be managed expeditiously.[13] However, a holistic approach to the older frail patient with multiple comorbidities is important; patient preferences need to be considered and the burden of further investigation weighed against possible benefits to the individual.
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