Lung cancer - solitary nodule; Infectious granuloma - pulmonary nodule; SPN
A solitary pulmonary nodule is a round or oval spot (lesion) in the lung that is seen with a chest x-ray or CT scan.
More than half of all solitary pulmonary nodules are noncancerous (benign). Benign nodules have many causes, including scars and past infections.
Infectious granulomas (which are formed by cells as a reaction to a past infection) cause most benign lesions. Common infections that often result in granulomas or other healed scars include:
Primary lung cancer is the most common cause of cancerous (malignant) pulmonary nodules. This is cancer that starts in the lung.
A solitary pulmonary nodule itself rarely causes symptoms.
Exams and Tests
A solitary pulmonary nodule is most often found on a chest x-ray or chest CT scan. These imaging tests are often done for other symptoms or reasons.
Your health care provider must decide whether the nodule in your lung is most likely benign or of concern. A nodule more likely benign 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 provider may then choose to monitor the nodule over time by repeating a series of x-rays or CT scans.
Your provider may choose to biopsy the nodule to rule out cancer if:
A lung needle biopsy may be done by placing a needle directly through the wall of your chest, or during procedures called bronchoscopy or mediastinoscopy.
Tests to rule out TB and other infections may also be done.
Ask your provider 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.
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.
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Gould MK, Donington J, Lynch WR, et al. Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 Suppl):e93S-e120S. PMID: 23649456 www.ncbi.nlm.nih.gov/pubmed/23649456.
Padley SPG, Lazoura O. Pulmonary neoplasms. In: Adam A, Dixon AK, Gillard JH, Schaefer-Prokop CM, eds. Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging. 6th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2015:chap 15.