What are Pulmonary Nodules?

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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

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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.

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




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