Respiratory - Solitary Pulmonary Nodules

What is a pulmonary nodule?

• A pulmonary nodule is an area of roundish shadowing usually 1cm or smaller in the lung
• It does not usually cause any symptoms but can be seen on a CT scan (Computed Tomography) and sometimes on a chest x-ray

Why do pulmonary nodules occur?

• Pulmonary nodules are very common. Approximately 1 in 4 (25%) of older people who smoke or who are ex-smokers have nodules on a CT scan
• People who have never smoked may also have nodules on a CT scan
• Most nodules are benign (non-cancerous) and may be caused by scarring from previous lung infections. Some of the smaller nodules may even reflect normal lung immune tissue
• They are very common in people who have had TB (tuberculosis), and can occur in people who have had other conditions such as rheumatoid arthritis
• In a small number of people the nodule could be a very early lung cancer or occasionally a secondary cancer that has spread from elsewhere in the body

Diagnosing pulmonary nodules

• Nodules are sometimes found on a chest x-ray but in most cases they are too small and are only seen when the person has a CT scan
• Pulmonary nodules are often found when the person is having a CT scan for another reason
• It is not always possible to know what the cause of a nodule is from the CT scan alone
• Because nodules are small, a biopsy (a test performed to get a piece of the nodule) may be very difficult. Instead, we monitor the size of the nodule by repeating the CT scan after a certain amount of time to see whether it grows
• Benign (non-cancerous) nodules grow very slowly, or may not grow at all. On the other hand, malignant (cancerous) nodules will eventually grow, though this can happen slowly
• We can check if the nodule is changing by repeating a chest x- ray or CT scan over a period of months or years
• Because nodules can change very slowly there is no point in doing chest x-rays or CT scans any sooner than this

What happens next?

• A repeat chest x-ray or CT scan will be arranged. This is often done three months after your first chest x-ray or CT scan, but it could be 6-12 months in some cases. Some nodules require no further CT scans
• It may be necessary to have a number of CT scans over 2 years or more. This will depend on:
  ○    the appearance of the nodule
  ○    your general health
• If the nodule grows or changes in any way then your chest specialist (doctor) may arrange for you to have further tests
• In some cases you may have another type of scan arranged called a PET-CT (Positron Emission Tomography) which can provide additional information
• Your chest specialist will discuss your information at a team meeting with other specialist doctors and nurses
• Your chest specialist will either write to you or see you in clinic to inform you of the result of your scan. This should be soon after your CT scan
• If you have any of the following symptoms between your scans, then you should inform one of our nurse specialists on the telephone number provided or your GP who may wish to contact your chest specialist to see you sooner.
• Pain in your chest
• Shortness of breath
• Repeated chest infections
• Coughing up blood

Contact details

If you have any questions or worries about your condition please contact the The Specialist Lung Nurses, Department of Respiratory Medicine, Salford Royal Hospital, Stott Lane, Salford, M6 8HD.
Telephone: 0161 206 5771/0161 206 1498
Email: respiratory.info@nca.nhs.uk