Managing Incidental Findings on Thoracic CT: Mediastinal and Cardiovascular Findings
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Incidental mediastinal lymph node
FDG PET/CT is recommended directly in young males with incidental enlarged nodes due to concerns for lymphoma and metastatic germ cell tumors.
FDG PET/CT is recommended directly in young males with incidental enlarged nodes due to concerns for lymphoma and metastatic germ cell tumors.
Applies to Any size.
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PET/CT or tissue sampling
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Management by pathology
Primary care evaluation and consideration of pulmonary consultation for unexplained mediastinal lymphadenopathy ≥15 mm.
Applies to ≥ 15 mm.
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Primary care evaluation and consideration of pulmonary consultation for unexplained mediastinal lymphadenopathy ≥15 mm.
For incidental mediastinal lymph nodes ≥15 mm without a benign explanation or known malignancy, consider clinical evaluation and follow-up chest CT in 3–6 months.
Applies to ≥ 15 mm.
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Follow-up 3–6 months
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Re-assess stability
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Continue or stop
Primary care evaluation; consider pulmonary consultation; consider follow-up chest CT.
Applies to ≥ 15 mm.
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Follow-up 3–6 months
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Re-assess stability
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Continue or stop
Decision tree
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References
- PrimaryMunden RF, Carter BW, Chiles C, MacMahon H, Black WC, Ko JP, et al. Managing Incidental Findings on Thoracic CT: Mediastinal and Cardiovascular Findings: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol. 2018 Aug;15(8):1087-1096.
Frequently asked
Which findings does Managing Incidental Findings on Thoracic CT: Mediastinal and Cardiovascular Findings cover?
This guideline provides recommendations for Incidental mediastinal lymph node.
What follow-up is recommended for larger incidental mediastinal lymph node?
≥ 15 mm: Primary care evaluation and consideration of pulmonary consultation for unexplained mediastinal lymphadenopathy ≥15 mm..
Does this guideline apply to oncology patients?
No — patients with known malignancy fall outside the scope unless the guideline states otherwise. Follow oncologic surveillance protocols instead.