Incidental Pulmonary Nodule on CT
Solid or subsolid nodule discovered incidentally
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RadiologyDiagnostic
Incidental Pulmonary Nodule Management (Fleischner 2017)
Incidental Pulmonary Nodule Management (Fleischner 2017): Incidental Pulmonary Nodule on CT → Nodule Morphology? → Solid Nodule Size? → Risk Assessment ...
Pathway Overview
14 steps
Algorithm Steps
14 total
01Start 02Decision Nodule Morphology?
Solid, part-solid, or pure ground glass
- Solid nodule
- Part-solid (GGO with solid component)
- Pure ground glass (GGO)
03Decision Solid Nodule Size?
- <6mm
- 6-8mm
- >8mm
04Decision Risk Assessment (<6mm)
- Low risk patient
- High risk patient
05End No Routine Follow-up
Optional 12-month CT if high-risk features
06End Optional 12-Month CT
Consider follow-up if risk factors present
07Action 6-8mm Follow-up
Low risk: 6-12mo, then 18-24mo; High risk: same + stability
08Action >8mm Management
CT at 3 months, PET/CT, or tissue sampling
09Decision Part-Solid Size?
- <6mm
- ≥6mm solid component
10End No Routine Follow-up
Consider 3-6mo CT if suspicious
11Action 3-6 Month CT
If persistent, PET/CT or biopsy based on solid component
12Decision Pure GGO Size?
- <6mm
- ≥6mm
13End No Routine Follow-up
14End CT at 6-12 Months
Then q2y for 5 years if persistent
Guideline Source
Fleischner Society 2017 Guidelines for Management of Incidental Pulmonary Nodules
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Does not apply to lung cancer screening populations
- Does not apply to immunocompromised patients
- Not for patients with known primary malignancy
- Age <35 may warrant different approach
Contraindicated Populations
Lung cancer screening patientsKnown malignancy
Applicable Regions
USAUUKEU
AU: Follow ACR/Fleischner approach
UK: BTS guidelines similar but with slight threshold differences
US: Lung-RADS for screening populations differs from Fleischner
Version 1Next review: 2028-01-01
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Related Resources
Frequently Asked Questions
What is the Incidental Pulmonary Nodule Management (Fleischner 2017)?
The Incidental Pulmonary Nodule Management (Fleischner 2017) is a diagnostic clinical algorithm for Radiology. It provides a structured decision tree to guide clinical decision-making, based on Fleischner Society 2017 Guidelines for Management of Incidental Pulmonary Nodules.
What guideline is the Incidental Pulmonary Nodule Management (Fleischner 2017) based on?
This algorithm is based on Fleischner Society 2017 Guidelines for Management of Incidental Pulmonary Nodules (DOI: 10.1148/radiol.2017161659).
What are the limitations of the Incidental Pulmonary Nodule Management (Fleischner 2017)?
Known limitations include: Does not apply to lung cancer screening populations; Does not apply to immunocompromised patients; Not for patients with known primary malignancy; Age <35 may warrant different approach. Individual patient factors may require deviation from these recommendations.
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