A solitary pulmonary nodule is a single round spot in the lung, 3 cm or smaller, surrounded by normal lung tissue. Most are benign scars or old infections and some are early lung cancer, so the job is to judge the risk and choose the right follow-up.
Key symptoms
- Usually no symptoms; found on an X-ray or CT done for another reason
- Cough or blood-streaked sputum in some patients
- Weight loss or fatigue that raises concern for cancer
- Risk history: smoking, age over 50, asbestos or radon exposure, prior cancer
What you find on exam
- Often a normal exam
- Clubbing of the fingers
- Enlarged lymph nodes above the collarbone
- Signs of infection or of a cancer elsewhere
Tests
- Compare with old chest images; a solid nodule stable for 2 years is likely benign
- Chest CT: size, edges, calcification and solid or ground-glass texture
- Risk estimate and follow-up interval based on Fleischner Society guidance
- PET-CT, biopsy (CT-guided or bronchoscopic) or surgery for higher-risk nodules
Treatment basics
- Small low-risk nodules: no follow-up or repeat CT at set intervals
- Intermediate risk: PET-CT or biopsy to decide the next step
- High risk or proven cancer: surgical removal, or stereotactic radiation if surgery is not possible
- Smoking cessation and lung cancer screening for eligible patients
Red flags
- Nodule growing on follow-up imaging
- Coughing up blood or unexplained weight loss
- Spiculated edges or a large solid nodule in a smoker
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.