Patient education: Multiple pulmonary nodules (The Basics)

What are multiple pulmonary nodules? — Pulmonary nodules, also called lung nodules, are "spots" on the lungs that are 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's called "multiple" pulmonary nodules.

What causes multiple pulmonary nodules? — Multiple pulmonary nodules are caused by either:

●Cancer – Multiple pulmonary nodules can be caused by cancer that started in another part of the body and then spread to the lungs. 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

•Clumps of abnormal blood vessels, called arteriovenous malformations (or "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 chicken pox

How will my doctor know what is causing my pulmonary nodules? — Your doctor will ask about your symptoms and other medical conditions. They will want to know whether you worked around harmful substances that you could have breathed into your lungs. If you have not had a CT scan done, they will order this test.

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, they will look at those to see whether the spots have changed over time. If the spots have not changed on CT scans from 2 years ago (or longer), they are unlikely to be cancer.

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

●Blood tests

●A skin test for tuberculosis

●Lab tests on samples of mucus that you cough up

●An imaging test called a PET scan – If some of the nodules are 1/3 of an inch or bigger, your doctor might order 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 test can help tell whether pulmonary nodules are likely to be cancer.

●A procedure called bronchoscopy – For this test, your doctor will put a thin tube with a camera and light on the end (called a "bronchoscope") in your mouth and down into your lungs. During this test, they can get 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 that the nodules are cancer or a disease that needs treatment (like an infection), your doctor will do a biopsy. A biopsy is a test that can tell for certain what's causing your pulmonary nodules. During a biopsy, your doctor will get a sample of tissue from 1 of your pulmonary nodules. Then, another doctor will look at the sample under a microscope.

There are different ways that a doctor can do a biopsy. 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 of tissue

●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 what they recommend.

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

More on this topic

Patient education: Lung cancer (The Basics)
Patient education: Tuberculosis (The Basics)
Patient education: Granulomatosis with polyangiitis (The Basics)
Patient education: Lymphoma (The Basics)
Patient education: Kaposi sarcoma (The Basics)
Patient education: Pulmonary nodule (The Basics)
Patient education: Diagnostic bronchoscopy (The Basics)