A 25-year-old is seen in the clinic for assessment of an incidental finding on a CXR of a 2-cm solitary pulmonary nodule in the left lower lobe. He feels well and reports no dyspnea, chest pain, or constitutional symptoms. He does not smoke and has never had a previous CXR. The physical examination is completely normal. The nodule has a “popcorn ball”-type calcification pattern. Which of following is the most appropriate next step in management?
Correct Answer: serial CXRs
Description: Signs of benignity of a solitary pulmonary nodule are lack of growth over a prolonged period and certain patterns of calcification. "Popcorn" calcification does suggest a benign hamartoma. A search for previous CXRs can provide a definitive diagnosis. In nonsmokers under age 35, 1% of solitary pulmonary nodules are malignant. In this patient, a follow up CXR to demonstrate stability of the lesion is more appropriate than biopsy or resection.
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