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What is a pulmonary nodule?

A fellow caregiver asked...

My mother has COPD. What is a Pulmonary Nodule?

Expert Answer

Loutfi S. Aboussouan is a staff physician for the Cleveland Clinic's Respiratory Institute and Neurological Institute. He is board certified in internal medicine, pulmonary disease, critical care medicine, and sleep medicine and directs the pulmonary curriculum for the second-year class of the Cleveland Clinic Lerner School of Medicine.

A pulmonary nodule usually refers to the finding on a chest X-ray or a CAT scan of a round spot which is less than 3 cm (about 1.2 inches) in diameter and found inside the lung tissue. Because of the size and shape, it is also know as a coin lesion. A pulmonary nodule would usually not cause any symptoms and is therefore often found by chance when a chest X-ray (or a CAT scan) is done for other reasons. Whereas most nodules are benign (meaning they are not due to cancer), they could still be an early form of malignancy (cancer), and perhaps more so in people with COPD such as your mother. The good news is that treating cancer at an early nodule stage could completely get rid of the cancer. The uncertainty as to whether the spot is benign or malignant results in a challenge for both patients and doctors. So I would encourage your mother to work closely with her primary or lung physician to make that determination. Here are a few things that might help:

  1. Many patients with COPD would have had chest X-ray or a CAT scan in the past for one reason or another. If the same spot can be found in the same size and shape on an older test (2 years or more), then the lesion is probably benign. If this film exists, please find it and have your mother bring it to her doctor (not just the report but the actual images)
  2. If the spot has calcium or fat inside then it is also probably benign. These would usually be best seen on a CAT scan of the lung, though a chest X-ray can also show calcium.
  3. There is a type of scan called PET scan which can also help decide whether the nodule is benign or malignant.
  4. There are two procedures by which a biopsy of the spot can be done: a bronchoscopy or a needle biopsy. The decision as to which one is best may depend on where the spot is
  5. Surgery is also an option which can provide a definitive answer and a treatment at the same time. However, if the COPD is severe, this may not be an option.