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Adenocarcinoma - chest X-ray
Adenocarcinoma - chest X-ray

Pulmonary nodule - front view chest X-ray
Pulmonary nodule - front view chest X-ray

Pulmonary nodule, solitary - CT scan
Pulmonary nodule, solitary - CT scan

Respiratory system
Respiratory system

Solitary pulmonary nodule

Definition:

A solitary pulmonary nodule is a round or oval spot (lesion) in the lungs that is seen with a chest x-ray or CT scan .



Causes, incidence, and risk factors:

More than half of all solitary pulmonary nodules are noncancerous (benign). Benign nodules have many causes, including old scars and infections.

Infectious granulomas (reactions to a past infection) cause most benign lesions. Common infections that increase the risk for developing a solitary pulmonary nodule include:

Lung cancer is the most common cause of cancerous (malignant) pulmonary nodules.



Symptoms:

The nodule itself rarely causes symptoms.



Signs and tests:

A solitary pulmonary nodule is most often found on a chest x-ray or a chest CT scan , which are often done for other symptoms or reasons.

Your doctor must decide whether the nodule in your lung is probably benign (not cancer). This is more likely if:

  • The nodule is small, has a smooth border, and has a solid and even appearance on an x-ray or CT scan
  • You are young and do not smoke

Your doctor may then choose to just watch the nodule on x-rays.

  • Repeat chest x-rays or chest CT scans are the most common way to follow the nodule. Rarely, lung PET scans may be done.
  • If repeated x-rays show that the nodule size has not changed in 2 years, it is most likely benign and a biopsy is not needed.

Your doctor may choose to biopsy the nodule to rule out cancer if:

  • You are a smoker
  • You have other symptoms of lung cancer
  • The nodule has grown in size or has changed compared to earlier x-rays

A lung needle biopsy may be done by placing a needle through the wall of your chest, or during bronchoscopy or mediastinoscopy .

Skin tests to rule out tuberculosis and other infections may also be done.



Treatment:

Ask your doctor about the risks of having a biopsy versus monitoring the size of the nodule with regular x-rays or CT scans. Treatment may be based on the results of the biopsy or other tests.



Support Groups:



Expectations (prognosis):

The outlook is usually good if the nodule is benign. If the nodule does not grow larger over a 2-year period, often nothing more needs to be done.



Prevention:



References:

Gould MK, Fletcher J, Iannettoni MD, et al. Evaluation of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132:108S-130S.

Wahidi MM, Govert JA, Goudar RK, et al. Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132:94S-107S.

Albert RH, Russell JJ. Evaluation of the solitary pulmonary nodule. Am Fam Physician. 2009;80:827-831.

Ettinger DS. Lung cancer and other pulmonary neoplasms. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 197.



Review Date: 8/24/2011
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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