Solitary pulmonary nodule

Definition

A solitary pulmonary nodule is a round or oval, sharply defined lung lesion seen on a Chest x-ray.

Causes, incidence, and risk factors

About 60% of all solitary pulmonary nodules are benign (not cancerous). Benign nodules have many causes, including old scars and infections.

Infectious granulomas (inflammations of granular tissue) are the cause of most benign lesions. When a nodule is malignant, lung cancer is the most common cause. Exposure to Tuberculosis or an infectious fungus (histoplasmosis, coccidioidomycosis) can increase the risk of developing a solitary pulmonary nodule, but also makes it more likely that the nodule is benign.

Young age, absence of tobacco exposure, calcium in the lesion, and small lesion size are factors favoring a benign diagnosis. About 150,000 new solitary pulmonary nodules are diagnosed each year in the United States. Of these, 45,000 require no further testing besides a careful history and review of an old Chest x-ray, if available.

Symptoms

There are usually no symptoms.

Signs and tests

A solitary pulmonary nodule is usually found on a Chest x-ray. If serial Chest x-rays (repeated x-rays over time) show the nodule size unchanged for 2 years, it is considered benign. A chest CT scan is often performed to evaluate a solitary pulmonary nodule in detail.

Other tests may include the following:

• PET scan
  
• Single-photon emission CT (SPECT)
  
• Skin tests to rule out infectious causes
  
• Percutaneous needle biopsy
  
• Surgical lung biopsy
  

Treatment
Most nodules in patients over 35 years old should be considered potentially malignant until proven otherwise. If the lesion is suspected to be benign, serial Chest x-rays or CT scans may be taken on a regular basis for observation of the lesion. If the affected person is at high risk for lung cancer or if the CT scan appearance of the lesion suggests it is malignant, surgical removal of the lesion (excisional biopsy) is recommended.