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Solid pulmonary nodule — ABIM Board MCQ

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HardPulmonary/Critical CareSolid pulmonary noduleABIM Board

A 67-year-old former smoker has an incidental 9-mm part-solid right upper-lobe nodule with a 4-mm solid component. There are no prior studies, adenopathy or infectious symptoms. Which surveillance plan best follows Fleischner guidance?

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Correct answer: A — Repeat thin-section chest CT in three to six months to confirm persistence

The best answer is “Repeat thin-section chest CT in three to six months to confirm persistence”. A part-solid nodule at least 6 mm should undergo short-interval thin-section CT to determine whether it persists. If persistent and the solid component remains below 6 mm, annual CT surveillance for five years is appropriate. Growth or a solid component reaching 6 mm increases suspicion and changes evaluation.

Reference: Fleischner Society 2017 Incidental Pulmonary Nodule Guideline: https://pubmed.ncbi.nlm.nih.gov/28240562/