Image-Guided Transthoracic Needle Biopsy There is no relevant literature to support the use of image-guided transthoracic needle biopsy (TNB) in the initial evaluation of incidentally detected indeterminate pulmonary nodules on chest radiographs. MRI Chest Without IV Contrast There is no relevant literature to support the use of MRI chest in the initial evaluation of incidentally detected indeterminate pulmonary nodules on chest radiographs. Incidentally Detected Indeterminate Pulmonary Nodule MRI Chest Without and With IV Contrast There is no relevant literature to support the use of dynamic MRI chest in the initial evaluation of incidentally detected indeterminate pulmonary nodules on chest radiographs. Radiography Chest About 20% of suspected nodules on chest radiographs prove to be pseudonodules. These are generally caused by rib fractures, skin lesions, anatomic variants, or overlapping structures [25]. Repeat radiographs with nipple markers, chest fluoroscopy, oblique chest views, and dual-energy subtraction radiography have been described to help distinguish between a pulmonary nodule and a pseudonodule to avoid additional or invasive workup [25]. There is insufficient literature to support their widespread use, and validation studies are needed to measure the effectiveness of newer techniques like dual-energy subtraction. Despite the lack of sufficient literature supporting these methods, the panel consensus was that a repeat chest radiograph is a common practice and may be a useful next step when a pseudonodule is suspected on a radiograph. When encountering indeterminate solid nodules on chest radiograph, ACCP guidelines recommend thin-section chest CT as the next step unless prior imaging is available to prove stability over 2 years (grade 1C recommendation) [2]. The purpose is to better characterize the nodule and asses its malignant potential.
Incidentally Detected Indeterminate Pulmonary Nodule PCAs. Image-Guided Transthoracic Needle Biopsy There is no relevant literature to support the use of image-guided transthoracic needle biopsy (TNB) in the initial evaluation of incidentally detected indeterminate pulmonary nodules on chest radiographs. MRI Chest Without IV Contrast There is no relevant literature to support the use of MRI chest in the initial evaluation of incidentally detected indeterminate pulmonary nodules on chest radiographs. Incidentally Detected Indeterminate Pulmonary Nodule MRI Chest Without and With IV Contrast There is no relevant literature to support the use of dynamic MRI chest in the initial evaluation of incidentally detected indeterminate pulmonary nodules on chest radiographs. Radiography Chest About 20% of suspected nodules on chest radiographs prove to be pseudonodules. These are generally caused by rib fractures, skin lesions, anatomic variants, or overlapping structures [25]. Repeat radiographs with nipple markers, chest fluoroscopy, oblique chest views, and dual-energy subtraction radiography have been described to help distinguish between a pulmonary nodule and a pseudonodule to avoid additional or invasive workup [25]. There is insufficient literature to support their widespread use, and validation studies are needed to measure the effectiveness of newer techniques like dual-energy subtraction. Despite the lack of sufficient literature supporting these methods, the panel consensus was that a repeat chest radiograph is a common practice and may be a useful next step when a pseudonodule is suspected on a radiograph. When encountering indeterminate solid nodules on chest radiograph, ACCP guidelines recommend thin-section chest CT as the next step unless prior imaging is available to prove stability over 2 years (grade 1C recommendation) [2]. The purpose is to better characterize the nodule and asses its malignant potential.