What are Pulmonary Nodules?

lungs, pulmonary nodules, pulmonary nodule, cancer, x-rayIf you’ve recently had a chest X-ray and been told you have pulmonary nodules, you probably have a lot of questions. How long have they been there? What caused them? 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 (non-cancerous). What’s more, if a lung nodule is malignant (cancerous), there’s a very good chance it can be cured.

What is a Pulmonary Nodule?

Also referred to as a “spot on the lung” or a “coin lesion,” a pulmonary nodule is a small, round or oval-shape growth in the lung. It’s the size of the growth that determines whether it’s 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.

Causes of Pulmonary Nodules

Benign pulmonary nodules can have many causes, the most common being from inflammation as a result of an infection or disease that’s producing it in the body. Pulmonary nodules can also be caused by the formation of scar tissue, for example from having a history of tuberculosis. Other causes include:

  • Non-infectious disorders such as sarcoidosis (abnormal collection of inflammatory cells that form lumps) or Wegener’s granulomatosis (a condition causing inflammation of the blood vessels).
  • Neoplasms, such as fibromas (abnormal growth of fibrous tissues), neurofibromas (abnormal growth of nerve tissue) or blastomas (abnormal growth of immature cells).

Types of malignant tumors include lung cancer, lymphomas (abnormal growths containing lymphoid tissues), carcinoids (small, slow-growing cancerous tumors), sarcomas (cancerous growths of connective tissue) and metastatic tumors (tumors that spread to the lungs from other parts of the body).

Symptoms of Pulmonary Nodules

Pulmonary nodules are usually asymptomatic, meaning they’re not associated with any symptoms. Most people are unaware of their development 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 cough or hemoptysis (coughing up blood).

Diagnosis of Pulmonary Nodules

lungs, pulmonary nodules, pulmonary nodule, cancer, x-rayAs stated above, most lung nodules are found during a chest X-ray or CT scan. Additional diagnostic tests include a PET (positron emission tomography) scan, a bronchoscopy and a needle biopsy.  Although the majority of lung nodules are benign, it’s still important they be diagnosed early when they’re able to be cured.

When first identified, your doctor will gather information about your history to determine the likelihood of the growth being cancerous. Information gathered may include your smoking history, whether you’ve had cancer in the past or you have a family history of cancer and your history of exposure to environmental toxins.

Your doctor may also request copies of previous imaging test results to determine if the nodule has grown. If first identified on a chest X-ray, she 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 she can track the growth over time to denote changes. If features of the nodule are concerning, the best approach may be to remove it.

Treatment of Pulmonary Nodules

Benign pulmonary nodules usually don’t require any treatment. However, if the nodule is the result of inflammation or an active infection, the emphasis of treatment should be on the underlying condition. If the growth is determined to be cancerous but it hasn’t yet spread and the patient is healthy enough for surgery, the nodule should be surgically removed.

If a non-surgical biopsy has been performed and there is a high concern that the growth is malignant, even though the results may be 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’s inserted through a small incision on the chest.

Prevention of Pulmonary Nodules

The best way to prevent a pulmonary nodule is to never smoke, or to quit smoking immediately, if you’re a smoker.

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

10 thoughts on “What are Pulmonary Nodules?”

  1. 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. 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. 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. 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. 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.

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