Solitary pulmonary nodules are a frequent finding in chest imaging, presenting as a diagnostic challenge due to the possibility of both benign and malignant etiologies, requiring a complete guide for a more accurate, updated, and standardized guide for clinicians.This narrative review comprehensively explores SPNs, encompassing their definition, epidemiology, etiology and pathogenesis, imaging findings, follow-up strategies, and treatment options.SPNs are incidentally detected in 0.1-0.2% of chest X-rays and 13% of CT scans in the general population.However, the prevalence increases significantly (17-53%) among those with high-risk factors like smoking.Age and smoking history are the most significant risk factors, with men having a slightly higher incidence than women.A wide range of conditions can cause SPNs, including benign processes like granulomas, hamartomas, and inflammatory nodules and malignant etiologies such as primary lung cancer and metastatic disease.Infectious agents like aspergillus and tuberculosis can also manifest as SPNs.Additionally, autoimmune diseases and congenital malformations can be presented as SPNs.Chest X-ray can detect SPNs, but CT scans provide detailed anatomical information crucial for characterization.Imaging features like size, shape, margins, calcifications, and enhancement patterns are vital in differentiating benign from malignant nodules.PET scans may assess metabolic activity and aid in the evaluation of malignancy.Effective follow-up involves clinical assessment, risk stratification, and serial imaging (primarily CT scans).The frequency of follow-up imaging depends on the risk of malignancy and stability of the SPN.A multidisciplinary approach involving radiologists, pulmonologists, thoracic surgeons, and oncologists is crucial for optimal management.Management of SPNs depends on the underlying etiology.Benign nodules may require no intervention or surgical resection for symptomatic lesions.Malignant nodules typically require surgical resection, chemotherapy, radiation therapy, or a combination of these modalities.The role of PET scans and biopsy techniques in evaluating SPNs continues to evolve.Future advancements may provide more accurate and less invasive diagnostic tools.SPNs pose a diagnostic challenge due to their diverse etiology.A comprehensive evaluation is essential for accurate diagnosis and optimal patient management.