A Solitary Pulmonary Nodule (SPN) MUST be evaluated. SPN's are seen in about 2/1000 chest films. Small (<1.0 cm) nodules - especially in young patients, and are most commonly benign (e.g. hamartoma). However, since an SPN may be cancer, and survival in Ca is improved with early resection (5yr for a 1cm is 80% but for 3cm nodule drops to 50%).

Evaluation methods include:
• high-resolution CT (looking for calcium, margins, etc)
• serial followup studies
• retrospective review (look at older images)
• biopsy or resection


If watchful waiting is used, most benign processes do NOT grow, or grow very slowly. Acute inflammatory process may grow very rapidly. One reasonable follow up schedule:
• 4 weeks
• 6 weeks
• 3 months
• 4-6 months up to 2 years


Followup imaging in 4 weeks, DOUBLE tumor volume increases DIAMETER by only 28%
Doubling Time < 20 days is usually inflammatory
Most tumors double in 25 - 450 days with a median for Lung CA of 120 days. Any growth may prompt biopsy and/or resection.

References: Click for HyperLink


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SPN - Risk Calculations:
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