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Solitary pulmonary nodules (SPN) are commonly defined as well-marginated, round lung opacities with a diameter of 3 cm or less. This definition excludes poorly marginated or irregular opacities that are a common initial manifestation of lung cancer. In order to encompass these abnormalities, this definition is either not strictly adhered to or the term solitary pulmonary nodule is replaced by the more loosely defined term solitary pulmonary opacity. Solitary pulmonary opacities, including SPNs, are a common radiological finding with an estimated 150,000 detected annually [1]. Although most are benign and usually the sequela of pulmonary infections, lung cancer constitutes an important proportion of solitary pulmonary opacities. Although only 20-30% of patients with non-small-cell lung cancer present with a solitary nodule, these patients are potentially curable if surgical resection is performed [2,3]. Unfortunately,

Figure 1 Pulmonary nodule detected on chest radiograph (not shown) in a 61-year-old asymptomatic man with history of cigarette smoking. Computed tomography shows a small, well-circumscribed, noncalcified nodule in right upper lobe (arrow). Because of the high probability of malignancy, the nodule was resected and revealed a noncase-ating granuloma.

Figure 1 Pulmonary nodule detected on chest radiograph (not shown) in a 61-year-old asymptomatic man with history of cigarette smoking. Computed tomography shows a small, well-circumscribed, noncalcified nodule in right upper lobe (arrow). Because of the high probability of malignancy, the nodule was resected and revealed a noncase-ating granuloma.

it can be difficult to prospectively identify these malignant nodules and consequently many resected nodules are benign (Fig. 1). The morbidity and high cost associated with unnecessary resection have provided the impetus to improve noninvasive evaluation of solitary pulmonary opacities. This chapter reviews evaluation strategies and recent advances in imaging that can improve the accuracy of differentiating benign and malignant solitary pulmonary opacities.

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