Management of patients with Solitary Pulmonary Nodules (SPN) is primarily targeted at achieving an early diagnosis and treatment of all malignant nodules. We herein aimed to assess the adherence of pulmonologists to current clinical practice guidelines for SPN evaluation in a tertiary referral center for thoracic diseases. The medical records of 64 patients with SPN, diagnosed and treated at Sotiria Hospital for Chest Diseases from January 2017 to September 2018 were retrospectively reviewed. Following analysis of the clinical features and imaging characteristics of all cases, the probability of malignancy was evaluated, and the management approach followed by pulmonologists was compared to the approach suggested by issued guidelines. We observed a tendency by pulmonologists to monitor all SPN irrespective of size, density and likelihood of malignancy and reassess them at an earlier time than recommended by guidelines. Use of PET/CT in solid nodules >8 mm of very low (50%) and high (80%) probability of malignancy was also observed, despite lack of a clear indication of PET/CT in the above patients’ groups. Conventional bronchoscopy was performed in 81% of patients with a SPN of >8 mm with intermediate and high probability of malignancy, even though this is not typically recommended. A low-dose protocol was applied in the majority of SPN cases monitored by computed tomography, in accordance with guidelines. Malignancy was diagnosed in 42/64 patients. Pulmonologists in real-world practice may adopt a more "aggressive” management approach towards patients with SPN, so as to exclude the possibility of an underlying malignancy.