Patient education: Multiple pulmonary nodules (The Basics)

What are multiple pulmonary nodules? — 

Pulmonary nodules, also called lung nodules, are "spots" on the lungs seen on a chest X-ray or CT scan. (These are imaging tests that create pictures of the inside of the body.) When there are 2 or more spots on the lungs, it is called "multiple" pulmonary nodules.

What causes multiple pulmonary nodules? — 

They are caused by either:

●Cancer – The nodules can be caused by cancer that started in the lung or spread to the lung from another part of the body. Sometimes, multiple pulmonary nodules are caused by other types of cancer, called lymphoma or sarcoma.

●Conditions that are not cancer – Most nodules are not cancer. Causes include:

•Different types of infections

•Conditions that involve inflammation, such as rheumatoid arthritis

•Clumps of abnormal blood vessels, called arteriovenous malformations ("AVMs")

•Conditions caused by breathing in harmful substances for many years

•Conditions caused by using illegal drugs like heroin

•Scars from an old infection that happened years ago, such as from a fungus, tuberculosis, or chickenpox

How do doctors figure out what is causing pulmonary nodules? — 

Your doctor will ask about your symptoms and other medical conditions. They will want to know whether you worked around harmful substances you could have breathed into your lungs. They will order a CT scan if you have not already had one.

Your doctor will look at your X-ray and CT scan to see the sizes and shapes of the spots, and where they are in your lungs. They might be able to tell the cause of the nodules based on this information.

If you have old chest X-rays or CT scans, your doctor will look at them to see if the spots changed over time. If the spots have not changed on CT scans from 2 years ago (or longer), they are less likely to be cancer.

Will I need more tests? — 

If your doctor suspects you have cancer, an infection, or inflammation, they will order more tests. These can include:

●Blood tests

●A tuberculosis skin test

●Lab tests on samples of mucus you cough up

●PET scan – If some of the nodules are 1/3 of an inch or bigger, your doctor might order an imaging test called a PET scan. For this test, a doctor puts a substance into your vein through a thin tube called an "IV." Then, a special camera takes pictures of your lungs. This can help show if pulmonary nodules are likely to be cancer.

●Bronchoscopy – The doctor will put a thin tube with a camera and light on the end (called a "bronchoscope") in your mouth or nose and down into your lungs. They can take samples of mucus from deep inside your lungs. Another doctor will look at the samples under a microscope and do tests on them.

If the results of these tests are unclear and there is a chance the nodules are cancer or a disease that needs treatment (like an infection), your doctor will do a biopsy. This is a test that can show for certain what's causing your pulmonary nodules. During a biopsy, your doctor will take a sample of tissue from 1 of your pulmonary nodules. Then, another doctor will look at the sample under a microscope.

Biopsies can be done in a few different ways. To get a sample of tissue from a pulmonary nodule, your doctor can:

●Put a needle through your chest and into a nodule in your lungs

●Do bronchoscopy to get a sample

●Do surgery to remove a pulmonary nodule

What happens next? — 

Based on your test results and individual situation, your doctor will decide if you need treatment for the nodules.

If your nodules are caused by a condition that needs treatment, your doctor will talk with you about a treatment plan.

If your doctor thinks your nodules are a scar on your lungs, you probably do not need treatment. But you might need follow-up visits or CT scans to make sure your condition doesn't change or get worse over time. Most people have repeat CT scans over the course of about 2 years, but it depends on your individual situation.

More on this topic

Patient education: Pulmonary nodule (The Basics)
Patient education: Lung cancer (The Basics)
Patient education: Lymphoma (The Basics)
Patient education: Kaposi sarcoma (The Basics)
Patient education: Rheumatoid arthritis (The Basics)
Patient education: Tuberculosis (The Basics)
Patient education: Tuberculosis screening tests (The Basics)
Patient education: Lung biopsy (The Basics)
Patient education: CT scan (The Basics)
Patient education: PET scan (The Basics)
Patient education: Diagnostic bronchoscopy (The Basics)

Patient education: Lung cancer risks, symptoms, and diagnosis (Beyond the Basics)
Patient education: Hodgkin lymphoma in adults (Beyond the Basics)
Patient education: Follicular lymphoma in adults (Beyond the Basics)
Patient education: Rheumatoid arthritis symptoms and diagnosis (Beyond the Basics)
Patient education: Tuberculosis (Beyond the Basics)
Patient education: Flexible bronchoscopy (Beyond the Basics)