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Management of Radiology Incidental Findings in the Lungs

Based on recommendations by the American College of Radiology (ACR), published as guidelines (white papers)

incidental-lungs

Which incidental & asymptomatic lung finding have you identified? *

Solid nodule

Multiple solid nodules

Solitary or multiple ground glass/part solid nodules

Pulmonary cysts

Ground glass opacities

Reticular opacities (not secondary to atelectasis, low lung volumes)

Which one best describes the patient? *

Limited life expectancy (any age)

Age < 35y

Age ≥ 35y AND general population

How is patient's general risk of malignancy? *

Low risk

High risk

What is the size of the largest or most concerning nodule? *

< 6 mm

6-8 mm

> 8 mm

What is the size of the nodule? *

< 6 mm

6-8 mm

> 8 mm

Which one best describes the patient? *

Age < 35y

Limited life expectancy (any age)

Age ≥ 35y AND general population

Solitary finding or multiple findings? *

Solitary

Multiple

What is the size of the nodule, or if multiple, the largest/most suspicious nodule? *

< 6 mm

≥ 6 mm

How is the lesion's composition? *

Ground glass

Part solid

Which parts of the lungs are the pulmonary cysts in? *

Upper lungs

Diffuse

Lower lungs

Are there other associated abnormalities? *

Ground glass attenuation in the lower lungs

Nodules

None

Which option best describes the finding(s)? *

Basilar secondary to atelectasis/low lung volumes

Acute (based on clinical history or comparison with prior imaging)

Chronic (based on clinical history or comparison with prior imaging)

Where are the findings located? *

Lower lung and subpleural predominance

Focal, nodular

Diffuse

Which associated findings are present? *

Air trapping on expiratory imaging

Crazy paving (septal thickening)

Which associated findings are present? *

Reticular fibrotic opacities with or without traction bronchiectasis

Areas of consolidation

Which option best describes the finding(s)? *

Scattered randomly

Subpleural with a basilar predominance

With smooth interlobular septal thickening

With nodular interlobular septal thickening

Are there any additional findings? *

Traction bronchiectasis, WITHOUT honeycombing

Traction bronchiectasis, AND honeycombing

Other findings such as diffuse nodules, predominant ground glass opacity, and cysts

No additional findings

What is the extent of reticular opacities? *

<5% of the lungs

Mild

Click here to visit the incidental findings page on ACR.

References:

Munden RF, Black WC, Hartman TE, et al. Managing Incidental Findings on Thoracic CT: Lung Findings. A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol. 2021;18(9):1267-1279. doi:10.1016/j.jacr.2021.04.014M

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Rad at Hand » Incidentaloma Managere » Management of Incidental Findings in the Lungs

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