Pulmonary Nodules

What is a pulmonary nodule?

A pulmonary nodule is a spot on your lung. On chest X-rays or a CT scan these nodules look different from the surrounding (normal) lung tissue.

It can be worrisome to hear that your imaging shows a nodule. But most lung nodules are benign (not cancerous).

What does ground glass opacity mean in a lung nodule?

You might see providers describe pulmonary nodules by how solid they look on an image. Ground glass opacity means the area is hazy and the provider can still see structures underneath it. Nodules can also be solid (they block the structures underneath them from view) or a mix of both solid and ground-glass opacity.

How common are pulmonary nodules?

Pulmonary nodules are common. Radiologists see pulmonary nodules in nearly 1 out of every 3 chest CT scans.

What are the symptoms of lung nodules?

Small lung nodules rarely cause symptoms. If the growth presses against your airway or is cancerous, you might experience:

• Chest pain
• Shortness of breath (dyspnea) or wheezing
• Chronic cough or coughing up blood
• Fatigue
• Hoarseness
• Loss of appetite and unexplained weight loss
• Recurring respiratory infections like bronchitis or pneumonia

What causes pulmonary nodules?

Infections, inhaled particles, inflammatory conditions, scarring and cancer can all cause pulmonary nodules. Some types of pulmonary nodules and their causes include:

• Infectious granulomas. These clusters of immune cells (granulomas) are the most common kind of benign nodules. Fungal lung infections or other lung infections like tuberculosis can cause them.
• Noninfectious granulomas. Autoimmune diseases like rheumatoid arthritis and sarcoidosis can cause noninfectious granulomas.
• Benign tumors. These include hamartomas, lipomas and adenomas.
• Cancerous tumors. The most common kinds of cancer that cause pulmonary nodules include non-small cell lung cancer, small cell lung cancer and carcinoid tumors.
• Atypical adenomatous hyperplasia. This is a condition that can lead to cancer.
• Scarring (fibrosis). Smoking, breathing in lung irritants and chemicals, and other causes can lead to lung scarring.

What are the complications of pulmonary nodules?

There’s a small possibility that a pulmonary nodule could be cancerous. Rarely, a noncancerous lung nodule may press against or block an airway. You may need surgery to remove the nodule to make breathing easier.

How is a pulmonary nodule diagnosed?

Most people find out they have a lung nodule after getting a screening test or an imaging test for an unrelated reason. If the nodule is suspicious for cancer or you have certain risk factors, your provider might recommend:

• Additional imaging, like a PET scan or CT scan
• Additional tests, such as blood tests or sputum tests, that look for infections or other causes of pulmonary nodules
• Getting a tissue sample (biopsy)
• Removing the entire nodule

Can a CT scan tell if a lung nodule is cancerous?

No, a provider can’t tell by looking at a CT scan whether a lung nodule is cancerous — only a biopsy can diagnose cancer. But certain features help you provider determine whether you need a biopsy, or if a pulmonary nodule looks benign. For instance, small nodules (smaller than 0.6 centimeters) and those with smooth edges are usually less likely to be cancerous.

When do you need a biopsy for a pulmonary nodule?

Your provider is likely to recommend a biopsy if a nodule is larger than 9 millimeters, or you have certain risk factors for lung cancer. Risk factors include:

• You smoke or used to smoke
• You’re older than 65
• You have a family history or personal history of cancer
• You’ve received radiation therapy to your chest
• You’ve had exposure to asbestos, radon or secondhand smoke

How do providers biopsy a pulmonary nodule?

Procedures your provider might perform to get a biopsy or surgically remove the entire nodule include:

• Bronchoscopy
• Thoracoscopy
• Video-assisted thoracic surgery (VATS)
• Needle biopsy

How are pulmonary nodules treated?

Small, noncancerous lung nodules don’t usually require treatment. If you have pulmonary nodules caused by an infection, you might need medications to treat the infection. These could include antibiotics or antifungal medications.

Depending on your health history and the size of the nodule, your provider may recommend active surveillance. You’ll get additional imaging in six to 12 months. Nodules that stay the same size during a two-year surveillance period aren’t likely to be cancer.

If the nodule grows or causes symptoms, you may need surgery.

Can pulmonary nodules be prevented?

There isn’t much you can do to prevent benign lung nodules. But if you smoke, quitting is the best thing you can do to keep your lungs healthy.

What can I expect if my provider finds a lung nodule?

If you have a pulmonary nodule, you might need to follow up with your provider for additional tests or surveillance. Benign nodules will usually stay the same size or even go away on their own. They usually don’t cause symptoms.

Can pulmonary nodules turn into lung cancer?

Sometimes, a nodule that looks benign can begin to grow. That’s why your provider might recommend monitoring it for changes.

What is the survival rate for pulmonary nodules?

Since most pulmonary nodules aren’t harmful, they don’t affect your survival. If you have a cancerous nodule, the survival rate depends on many factors, including the type of cancer and the stage.

When should I see my healthcare provider?

Contact your healthcare provider if you have questions about a finding on an imaging report, like a pulmonary nodule. You may need follow-up testing. Let your provider know if you start experiencing symptoms of a lung condition, like shortness of breath or a chronic cough.

When should I go to the ER?

Go to the emergency room or call 911 if you experience:

• Chest pain
• Difficulty breathing
• Coughing up blood

What questions should I ask my doctor?

It might be helpful to ask your healthcare provider:

• What might have caused this nodule?
• Do I need follow-up testing?
• Are there any symptoms I should look out for?