Lung Nodules
A lung nodule is usually diagnosed on Chest x ray or CT scan and is usually asymptomatic unless it involves the chest wall when it can cause pain or the airways when it can cause bleeding and coughing of blood.
They can vary in size and can be due to scarring, infection, benign tumours and primary or secondary lung cancer.
The size and appearance of the nodules can give an indication or the likely cause but generally further investigations will be required. These can include:
PET scans, which are a type of CT scan designed to assess the activity of the nodule, generally cancers and some infections will be active or hot on the PET scan.
Bronchoscopy which involves passage of a flexible tube through the nose or mouth and into the lungs to allow samples to be taken. This procedure is done as a day case in hospital with a combination of light anaesthetic and local anaesthetic to numb the throat and is quite safe even in people with poor lung reserve.
CT guided biopsy which is performed in the radiology department. A needle is placed directly through the skin under CT guidance into the lung nodule to allow samples to be taken.
Subsequent management will depend on the likely diagnosis.
Benign Lung Nodules
These can be due to benign growths in the lung such as carcinoids and hamartomas or some forms of infection and occasionally inflammatory conditions such as sarcoidosis and rheumatoid arthritis.
They are not generally considered serious but often require removal to confirm the diagnoisis and direct subsequent treatment. This can usually be done with keyhole surgery and involves removing the nodule with a small margin of surrounding normal lung. It generally requires 1-2 nights in hospital.
If the nodule is small and not suspicious then removal may not be required and it can be followed with subsequent CT scans generally every 3-6 months to assess for changes in size and appearance.