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Concept
Lung nodule
Summary
A lung nodule or pulmonary nodule is a relatively small focal density in the lung. A solitary pulmonary nodule (SPN) or coin lesion, is a mass in the lung smaller than three centimeters in diameter. A pulmonary micronodule has a diameter of less than three millimetres. There may also be multiple nodules.
One or more lung nodules can be an incidental finding found in up to 0.2% of chest X-rays and around 1% of CT scans.
The nodule most commonly represents a benign tumor such as a granuloma or hamartoma, but in around 20% of cases it represents a malignant cancer, especially in older adults and smokers. Conversely, 10 to 20% of patients with lung cancer are diagnosed in this way. If the patient has a history of smoking or the nodule is growing, the possibility of cancer may need to be excluded through further radiological studies and interventions, possibly including surgical resection. The prognosis depends on the underlying condition.
Not every round spot on a radiological image is a solitary pulmonary nodule: it may be confused with the projection of a structure of the chest wall or skin, such as a nipple, a healing rib fracture or electrocardiographic monitoring.
The most important cause to exclude is any form of lung cancer, including rare forms such as primary pulmonary lymphoma, carcinoid tumor and a solitary metastasis to the lung (common unrecognised primary tumor sites are melanomas, sarcomas or testicular cancer). Benign tumors in the lung include hamartomas and chondromas.
The most common benign coin lesion is a granuloma (inflammatory nodule), for example due to tuberculosis or a fungal infection, such as Coccidioidomycosis. Other infectious causes include a lung abscess, pneumonia (including pneumocystis pneumonia) or rarely nocardial infection or worm infection (such as dirofilariasis or dog heartworm infestation). Lung nodules can also occur in immune disorders, such as rheumatoid arthritis or granulomatosis with polyangiitis, or organizing pneumonia.
Official source
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