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Practice Practice pointer

Pulmonary nodules

BMJ 2020; 371 doi: (Published 14 October 2020) Cite this as: BMJ 2020;371:m3673
  1. I T H Au-Yong, consultant thoracic radiologist1,
  2. W Hamilton, professor of primary care diagnostics2,
  3. J Rawlinson, patient advocate3,
  4. D R Baldwin, professor and consultant respiratory physician4
  1. 1Department of Radiology, Nottingham University Hospitals, Nottingham, UK
  2. 2University of Exeter Medical School, St Luke's Campus, Exeter EX1 2LU, UK
  3. 3British Thoracic Oncology Group (advocate steering committee member), NCRI Lung subGroup (consumer), and European Lung Foundation LC Patient advisory group, Sandwell, UK
  4. 4Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
  1. Correspondence to: Iain Au-Yong iauyong{at}

What you need to know

  • Pulmonary nodules are common incidental findings detected on computed tomography (CT) of the chest. Most are benign, but a small number represent early lung cancer

  • The optimal diagnostic approach facilitates timely and effective curative treatment while avoiding harmful interventions in benign disease

  • Familiarise yourself with the 2015 British Thoracic Society (BTS) and Fleischner Society guidelines, which provide updated guidance on management of incidentally detected nodules. Other guidelines are specific to nodules detected during screening for lung cancer

  • Consider the implementation and use of virtual pulmonary nodule clinics to facilitate management of patients with pulmonary nodules

Pulmonary nodules are defined as focal opacities that measure up to 3 cm in diameter and are surrounded by lung parenchyma, including those abutting the pleura. Pulmonary nodules are a common, usually incidental, finding on chest computed tomography (CT) scans, being reported in 20-50% of patients in screening trials.1 They are classified as solid or sub-solid, with the latter further divided into pure ground-glass and part-solid, based on CT appearance (fig 1).

Fig 1

Nodule types as seen on axial CT scans on lung window settings. Reproduced with permission from Callister et al.1 (A) Solid nodule: soft tissue density with sharply defined margins. (B) Part-solid nodule: has ground-glass density at its periphery but has a central component of soft tissue density. (C) Pure ground-glass nodule: entirely ground-glass in density

Nodules will be more frequently encountered with increasing use of imaging for a widening range of indications, including screening for lung cancer.

This clinical practice pointer aims to provide an overview of recent evidence and guidelines for non-specialist doctors, such as general practitioners, who may receive the results of CT scans or multidisciplinary team discussions, or may be faced with patients with further questions about pulmonary nodules.

Are pulmonary nodules becoming more common?

Pulmonary nodules are now identified more often because chest …

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