Synopsis
Turn an incidental pulmonary nodule into a proportionate, documented pathway using prior imaging, CT phenotype and validated malignancy risk while addressing other actionable thoracic findings.
- A pulmonary nodule is an imaging description, not a diagnosis; first confirm that the apparent opacity is intrapulmonary and characterise it on thin-section CT.
- Retrieve all prior chest imaging before ordering serial scans because long-term stability, true growth or a previously overlooked lesion can change the pathway immediately.
- Risk assessment integrates age, smoking, cancer history, nodule size, morphology and location; use the BTS-endorsed Brock model in its intended population rather than intuition alone.
Key red flags
Haemoptysis, a central obstructing lesion, lobar collapse, suspicious lymphadenopathy or a rapidly enlarging mass should enter an urgent lung-cancer pathway rather than routine nodule surveillance.
Investigation priorities
Establish whether the lesion is new, stable or genuinely growing.
Management branches
A chest radiograph or CT report describes a new solitary or multiple pulmonary nodule.
- Retrieve prior imaging and clinical context, including smoking, earlier malignancy, immune status, symptoms and whether an acute infective process is plausible.
- Obtain or reconstruct appropriate thin-section CT, documenting number, attenuation, morphology, lobe, dimensions or volume and every relevant non-nodule finding.