What is the recommended management plan for a patient with a calcified nodule in the lung, bilateral renal cortical cysts, mild wall thickening in the region of the gastroesophageal (GE) junction, and prominence of the mucosal folds in the second part of the duodenum?

Management of Incidental CT Findings: Calcified Lung Nodule, Renal Cysts, and GE Junction Wall Thickening

Calcified Lung Nodule (5.3 mm, Lingula)

No further imaging follow-up is required for this calcified pulmonary nodule. 1

• Fully calcified nodules are definitively benign and meet criteria for negative screening regardless of size 1
• The Fleischner Society explicitly states that smoothly marginated solid nodules with central or laminar calcification require no CT follow-up 1, 2
• Calcified nodules represent healed granulomas (often from prior histoplasmosis or other granulomatous infection) and contain no viable organisms 1
• Continue routine care without specific pulmonary surveillance 1

Bilateral Renal Cortical Cysts

These simple cortical cysts require no intervention or routine follow-up imaging.

• The 14.6 mm right upper pole and 7.3 mm left mid-pole hypodensities are consistent with simple cortical cysts (Bosniak I) 3, 4
• Simple renal cysts without enhancing soft tissue, thick walls, or septations are benign and require no surveillance 3, 5
• Correlation with prior ultrasound as suggested in the report is reasonable but not mandatory if CT characteristics are definitively benign 4
• The 2.8 mm nonobstructive right renal calculus requires no intervention; advise adequate hydration 4

Key distinction: The absence of enhancing soft tissue is the critical factor distinguishing benign from malignant cystic lesions, not the presence of calcification alone 3

GE Junction Wall Thickening (9.3 mm) and Duodenal Mucosal Prominence

Upper endoscopy (EGD) with biopsy is recommended to evaluate the GE junction wall thickening.

• Wall thickening at the GE junction measuring 9.3 mm exceeds normal limits (typically <5 mm) and requires tissue diagnosis 4
• Differential diagnosis includes:
  • Gastroesophageal reflux disease with esophagitis
  • Barrett's esophagus
  • Adenocarcinoma (gastric or esophageal)
  • Lymphoma
  • Eosinophilic esophagitis
• The prominence of duodenal mucosal folds is nonspecific but should be evaluated during the same endoscopy 4
• Obtain targeted biopsies of the GE junction abnormality and duodenal mucosa during EGD 4

Clinical correlation needed:

• Assess for dysphagia, odynophagia, weight loss, early satiety, or reflux symptoms
• Review medication history (NSAIDs, bisphosphonates)
• If patient has chronic GERD symptoms, this increases concern for Barrett's esophagus or adenocarcinoma

Additional Findings Requiring No Action

• Mitral valve calcification: Age-related degenerative change; no specific intervention unless symptomatic 4
• Small fatty umbilical hernia: Observe; repair only if symptomatic or enlarging 4
• Nonspecific perinephric stranding: Likely related to small renal calculus; no specific intervention 4
• Shotty para-aortic lymph nodes (9.3 mm): Within normal limits; no follow-up needed 4

Summary Algorithm

1. Lung nodule: No action required - definitively benign 1
2. Renal cysts: No action required - simple cysts 3
3. GE junction: Refer for upper endoscopy with biopsy 4
4. Duodenum: Evaluate during same endoscopy 4
5. Other findings: Routine clinical follow-up only 4

The only actionable finding requiring intervention is the GE junction wall thickening, which mandates endoscopic evaluation with tissue sampling.