Frequency and characteristics of pulmonary nodules in children at computed tomography

Abstract

BackgroundNormative data on pulmonary nodules in children without malignancy are limited. Knowledge of the frequency and characteristics of pulmonary nodules in healthy children can influence care decisions in children with malignant disease.ObjectiveTo provide normative data concerning the frequency and characteristics of pulmonary nodules on computed tomography (CT) in young children.Materials and methodsAll children ages 1 year–12 years who underwent chest CT after high-energy trauma were retrospectively investigated. Exclusion criteria were a history of malignancy, thick image slices, motion artefacts and extensive post-traumatic pulmonary changes. Two radiologists were asked to independently identify all nodules and to characterize each nodule with respect to location, size, perifissural location and calcification. Discrepancies were adjudicated by a third reader, who set the reference standard in this study. Interobserver agreement in detection and characterization was assessed using the kappa coefficient (κ).ResultsIdentified were 120 patients, of whom 72 (75% male; median age: 8.0 years [interquartile range: 4–11]) were included. A total of 59 pulmonary nodules were present in 27 patients (38%; 95% confidence interval: 26–49%; range: 1–5 nodules per patient, with a mean diameter of 3.2 mm [standard deviation: 0.9 mm]). For nodule detection, the per-patient interobserver agreement was substantial (κ=0.78) and per-lobe agreement was moderate (κ=0.40). For characterization, there was fair to substantial agreement (κ=0.36–0.74).ConclusionSmall pulmonary nodules on chest CT are a common finding in otherwise healthy children, but detection and characterization have only moderate interobserver agreement.

Measurements of cervical lymph nodes in children on computed tomography

“…Results show a small to medium correlation between lymph node size and age for Levels IV to VI. This finding is in line with earlier published normal measurements of chest lymph nodes in children [12]. Because the differences in lymph node size with increasing age are small, we believe that age-dependent normal values are not necessary in clinical practise.…”

Clinical implications of pulmonary nodules detected in children

“…Consistent with previous reports, we found that incidental nodules are detected in otherwise healthy children 3 . Even in those who had initial imaging due to respiratory symptoms, the nodule(s) may still be an incidental finding.…”

“…Previous pediatric studies assessed the incidence and characteristics of incidental nodules when chest computed tomography (CT) was performed on healthy children evaluated for trauma. Samim et al detected at least one nodule in 38% of pediatric trauma patients who had a chest CT, with substantial per patient interobserver agreement 3 . Renne et al 4 detected at least one nodule in 33% of pediatric trauma patients and concluded that nodules are detected frequently in children without known malignant disease.…”

“…Samim et al detected at least one nodule in 38% of pediatric trauma patients who had a chest CT, with substantial per patient interobserver agreement. 3 Renne et al 4 Committee acknowledge the limitations in available evidence and recommend that management be guided by the clinical history. 1,5 In this study, we employed a retrospective review to describe the characteristics, diagnostic work-up, and final diagnosis of pediatric patients found to have pulmonary nodules in our center.…”

Consistency of radiologists in identifying pulmonary nodules based on low-dose computed tomography

“…In addition to the actual incidence of pulmonary nodules, doctors' different detection and reporting of pulmonary nodules may be one of the possible reasons for the great variation. Samim et al (17) reported the agreement between two radiologists with respect to identification of pulmonary nodules was 0.78 kappa value in patient-based analysis and 0.40 in lobe-based analysis.…”