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.
Highlights
A pulmonary nodule in a child with known malignancy can be an important sign of metastatic stage
We identified 120 children who underwent chest computed tomography (CT) as part of their trauma evaluation
No thin slices were available and one patient was excluded due to a history of lymphoma. This resulted in a study sample of 72 patients (54 males) with a median age of 8.0 (IQR: 4–11) years and CT scans with a median slice thickness of 0.9 mm at 0.5– to 0.8–mm intervals
Summary
A pulmonary nodule in a child with known malignancy can be an important sign of metastatic stage. The prevalence and characteristics of nodules in children without malignancy are unclear. Knowledge of these normal values can influence future care decisions in children presenting with a malignancy. 32% to 65% of the metastasis-suspect nodules on CT in children with various malignancies were proven to be benign at biopsy [5,6,7,8]. To prevent unnecessary upstaging due to false-positive diagnosis, correct recognition of benign nodules is important. Knowledge of the frequency and characteristics of pulmonary nodules in healthy children can influence care decisions in children with malignant disease
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
