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What are Pulmonary Nodules?

lungs, pulmonary nodules, pulmonary nodule, cancer, x-ray

If you have recently had a chest X-ray and been told you have pulmonary nodules, you probably have a lot of questions. What is a nodule? How long has the nodule been there? What caused it? Could it be cancer?

The good news is, over 90% of pulmonary nodules that are smaller than 2 centimeters (3/4 inch) in diameter are benign, or non-cancerous, and the majority of lung nodules overall are benign as well. Additionally, even if a lung nodule is malignant, or cancerous, there is a very good chance it can be cured.

What is a Pulmonary Nodule?

If you are wondering, “What is a nodule?” the word “nodule” simply means a small lump. Also referred to as a “spot on the lung” or a “coin lesion,” a pulmonary nodule is a small, round or oval-shaped growth in the lung. The size of the growth in your lung is what determines whether it is deemed a pulmonary nodule or a pulmonary mass. Growths less than three centimeters (1.2 inches( in diameter are considered nodules while anything larger is referred to as a mass. A pulmonary mass is more likely to be malignant than a pulmonary nodule, though either has the potential to be cancerous.

What Is a Nodule in the Lung and How Common Are They?

Since the term “lung nodules” just refers to a small growth inside the lung, they occur more often than you might think. They are actually quite common and are found in one out of every 100 chest CT scans and one out of every 500 chest x-rays. In the United States alone, about 150,000 pulmonary nodules are found in patients per year. Though about half of smokers over the age of 50 will find nodules on a chest CT scan, you do not have to have a history of smoking to develop lung nodules.

Causes of Pulmonary Nodules

Benign pulmonary nodules can have many causes, the most common cause being inflammation resulting from an infection or disease in the body. Pulmonary nodules can also be caused by the formation of scar tissue, as might occur with a history of tuberculosis.

Causes of benign pulmonary nodules could include:

  • Non-infectious disorders causing inflammation, including rheumatoid arthritis, sarcoidosis, which is an abnormal collection of inflammatory cells that form lumps, or Wegener’s granulomatosis, a condition causing inflammation of the blood vessels
  • Fungal, bacterial or parasitic infections like histoplasmosis, aspergillosis, ascariasis (roundworms) and more
  • Neoplasms, including fibromas, which is the abnormal growth of fibrous tissues, neurofibromas, which is the abnormal growth of nerve tissue, or blastomas, which is the abnormal growth of immature cells

The causes of malignant pulmonary nodules or masses could include:

  • Lung cancer
  • Lymphomas: Abnormal growths containing lymphoid tissues
  • Carcinoids: Small, slow-growing cancerous tumors
  • Sarcomas: Cancerous growths of connective tissue
  • Metastatic tumors: Tumors that spread to the lungs from other parts of the body

Symptoms of Pulmonary Nodules

Pulmonary nodules are usually very small and asymptomatic, meaning they are not associated with any symptoms. However, some people could experience lung nodule symptoms that are similar to those of a respiratory infection like a chest cold or a mild flu. These symptoms could include wheezing, shortness of breath and repeated respiratory infections. Still, most people are unaware of the development of pulmonary nodules until they go for a chest X-ray or a CT scan when they have a lung infection. If the lung nodule is cancerous, however, the patient may experience a persistent cough or hemoptysis (coughing up blood). If you have lung nodules, symptoms could mean malignancy, so make sure you see your health care provider right away if you do experience symptoms.

Diagnosis of Pulmonary Nodules

lungs, pulmonary nodules, pulmonary nodule, cancer, x-ray

As stated above, most lung nodules are found accidentally during a chest X-ray or CT scan. Additional diagnostic tests for pulmonary nodules include a PET (positron emission tomography) scan, a bronchoscopy and a needle biopsy. Although the majority of lung nodules are benign, it is still important they be diagnosed as early as possible. Pulmonary nodules can still be cured early on, while they can become more difficult to eradicate if they are allowed to grow. Still, it is important to note that even cancerous lung nodules can often be cured.

When your lung nodule symptoms are first identified and the nodules are confirmed, your doctor will gather information about your personal and medical history to help determine whether the growth is cancerous. Your health care provider may request information about your smoking history, whether you have ever had cancer in the past, whether you have a family history of cancer and about your history of exposure to environmental toxins.

Your doctor may also request copies of previous imaging test results to determine if your pulmonary nodule has grown. If first identified on a chest X-ray, your health care provider may recommend a CT scan, which will provide more detailed information about the growth. If your test results indicate a low likelihood that your lung nodule is cancerous, your doctor may recommend follow-up tests so they can track the growth over time to denote changes. If features of the nodule are concerning, the best approach may be to remove it rather than wait or undergo additional testing. If a single pulmonary nodule remains unchanged for two or more years, it generally will not require further testing.

Treatment of Pulmonary Nodules

Benign pulmonary nodules usually do not require any treatment. However, if the nodule is the result of inflammation in your lungs or an active infection, treatment should be focused on the underlying condition. If the growth is determined to be cancerous, but it has not yet spread, the nodule should be surgically removed as long as the patient is healthy enough for surgery.

If a non-surgical biopsy has been performed and there is a high concern that the growth is malignant, even if the results are inconclusive, the growth should still be removed.

Surgical techniques that may be performed to remove pulmonary nodules include:

  • Thoracotomy: Open-lung surgery made through an incision in the chest to remove pieces of diseased lung tissue.
  • Video-assisted thoracoscopy: Performed through a flexible tube with a camera on one end that is inserted through a small incision in the chest.

Prevention of Pulmonary Nodules and Lung Nodule Growth

The best way to prevent a pulmonary nodule is to never smoke, or to quit smoking immediately, if you are a smoker. It is also important to seek medical advice and treatment if you have a lung infection of any kind, or if you have experienced significant exposure to environmental toxins. Finally, if you experience any lung nodules symptoms, see your health care provider right away to ensure that you catch the nodules as early as possible.

Source:
Cleveland Clinic. Pulmonary Nodules. Accessed September 30, 2017.

https://www.seattlecca.org/diseases/lung-cancer/pulmonary-nodules

https://www.verywellhealth.com/lung-nodules-symptoms-causes-and-diagnosis-2249304

11 thoughts on “What are Pulmonary Nodules?”

  1. Avatar Doug Hubka says:

    Don't know how unusual this is , but I have an allergic reaction to Aspergillus. Which create nodules that show up on a CT scan.

    1. Inogen Inogen says:

      Hi Doug, This isn't something I've heard of before but thank you for sharing!

  2. Avatar Johnni Bodoni says:

    is my spots curable?

    1. Inogen Inogen says:

      Hi Johnni, Benign pulmonary nodules usually don’t require any treatment as they are not cancerous. Are your spots benign or cancerous? Depending on the size and type of nodule it is, your spots may or may not require treatment. Please consult your primary care doctor for more information.

  3. Avatar J says:

    I have bronchiectasis as a result of Alpha-1 Antitrypsin Deficiency. Could this also be the cause of the nodules in my lungs?

    1. Inogen Inogen says:

      Hi J, Please consult your primary care doctor for more information.

  4. Avatar shirley mcelroy says:

    after a cat scan a nodule was visble on my right lower lung. Although it didnt " light up "the drs say the shape is suspecious and have scheduled a biopsey. is this common?
    I had colon cancer surgery with a resection one and 1/2 yrs ago

    1. Inogen Inogen says:

      Hi Shirley, Depending on your age and medical history your doctor may think preventative surgery is the right treatment for you.

  5. Avatar Laura McConley says:

    I have Lupus, RA, Emphysema. I have several nodules in both lungs discovered 2 years ago during a routine chest x-ray. At first there was only 2 or 3. But now seems to be more of them. The pulmonologist has me going for CT Scans every 6 months and the only thing he tells me about the results is "everything is ok", nothing more. But I am worried and that response does not help me feel any better. I feel as if he should have done or be doing something more in the way of diagnostics to find out what they are. I have thought about finding a new pulmonologist. What can I do?

    1. Inogen Inogen says:

      Hi Laura, Early detection is crucial to proper diagnosis and treatment. Based on your medical history, your pulmonologist is doing regular tests to make sure that your nodules are not growing in size. As mentioned in the article, CT scans provide more detail than chest x-rays and allows your pulmonologist to closely monitor the size and growth (if any) of your nodules. If you do not feel that your pulmonologist is giving you clear feedback on your diagnosis, getting a second opinion (from a different pulmonologist) is always a good idea. Please always consult your primary care doctor before making any changes to your treatment plan.

  6. Avatar Shirley Wyant says:

    I went to urgent care and they thought I had pneumonia. So they sent me straight to X-ray. When I was called with the results I was told no infection showed up , not pneumonia. But I have a small nodule on my left upper part of my lung . So I’m getting scheduled for a cat scan . My oxygen level is also low . No history of lung cancer on either side of my family .

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