Pulmonary Nodules: What You Need to Know

You went in for a CT scan — maybe to check on something unrelated — and the radiologist's report came back with an unexpected finding: a pulmonary nodule. Suddenly you have more questions than answers. What is it? Could it be cancer? What happens next?

First, take a breath. The vast majority of pulmonary nodules are benign. But they do need to be taken seriously, monitored appropriately, and in some cases, further evaluated. At PulmoCrit Associates, we have a dedicated Lung Nodule Program designed to give you a clear path forward — from initial evaluation to advanced diagnostic procedures if needed.

What Is a Pulmonary Nodule?

A pulmonary nodule is a small, round or oval-shaped growth in the lung, typically less than 3 centimeters (about 1.2 inches) in diameter. Larger growths are called lung masses and are evaluated differently. Nodules are often discovered incidentally — meaning they show up unexpectedly on imaging done for another reason, like a chest X-ray after an injury or a CT scan ordered for chest pain.

Nodules can appear in one or both lungs, and there may be a single nodule or multiple ones. They're more common than most people realize: studies estimate that pulmonary nodules are found in up to 1 in 4 CT chest scans performed in the United States each year.

What Causes Pulmonary Nodules?

There are many possible causes, most of them benign. The most common non-cancerous causes include:

• Past infections — Scar tissue left behind by healed bacterial infections (such as tuberculosis or histoplasmosis) or fungal infections is one of the most frequent explanations for lung nodules.
• Granulomas — These small clusters of inflamed cells form in response to infection, inflammation, or autoimmune conditions like sarcoidosis.
• Benign tumors — Hamartomas and other non-cancerous growths can form in lung tissue.
• Lymph node enlargement — Swollen lymph nodes near the lungs can sometimes appear as nodules on imaging.
• Rheumatoid nodules — In patients with rheumatoid arthritis, nodules can form in the lungs as part of the disease process.

In a smaller percentage of cases, a pulmonary nodule can represent an early-stage lung cancer or a metastasis from a cancer elsewhere in the body. This is why evaluation by a specialist matters.

How Do Doctors Determine If a Nodule Is Concerning?

Not every nodule requires aggressive workup. Pulmonologists use several key factors to assess the risk level and guide next steps:

Size

Smaller nodules (under 6 mm) in patients without significant risk factors often only need routine monitoring. Nodules larger than 8 mm carry a higher likelihood of being malignant and typically require closer evaluation, additional imaging, or a biopsy.

Shape and Density

The appearance of the nodule on CT scan provides important clues. Smooth, well-defined edges tend to be associated with benign causes. Irregular, spiculated (spiky) edges are more concerning. Nodules are also categorized by how they appear on a CT scan — as solid, part-solid (mixed), or ground-glass (hazy). Ground-glass and part-solid nodules can sometimes represent early, slow-growing lung cancers and may require longer follow-up even when small.

Growth Rate

Comparing imaging over time is one of the most important tools in nodule evaluation. Benign nodules often stay stable for years or even decades. A nodule that grows significantly over a short period warrants urgent evaluation. Conversely, a nodule that remains completely unchanged for two or more years is very unlikely to be cancerous.

Personal Risk Factors

Your pulmonologist will also consider factors like smoking history, age, occupational exposures (such as asbestos or radon), family history of lung cancer, and any prior cancers you may have had. These factors can shift the risk calculation substantially and influence how aggressively a nodule needs to be investigated.

What Happens After a Nodule Is Found?

The next steps depend on the nodule's characteristics and your risk profile. Common paths include:

Surveillance CT Scans

For low-risk nodules, the standard approach is watchful waiting with repeat CT scans at intervals recommended by your pulmonologist — commonly at 3, 6, or 12 months, and then annually for a period of time. These follow-up scans allow your doctor to monitor for any changes in size or appearance.

PET Scan

A positron emission tomography (PET) scan uses a small amount of radioactive material to highlight metabolically active tissue. Since cancer cells tend to be more metabolically active than normal cells, PET scans can help distinguish between a benign nodule and one that warrants biopsy. PET scans are most useful for nodules that are solid and larger than about 8 mm.

Bronchoscopy and Biopsy

When imaging alone isn't sufficient to determine whether a nodule is benign or malignant, a tissue sample (biopsy) is needed. The method used depends on the location and size of the nodule. This is where PulmoCrit's advanced procedural capabilities make a meaningful difference for our patients.

PulmoCrit's Lung Nodule Program

At PulmoCrit Associates, we take a comprehensive, coordinated approach to lung nodule management. When you're referred to our Lung Nodule Program, you receive a dedicated evaluation by one of our board-certified pulmonologists who will review your imaging, assess your risk factors, and develop a personalized management plan. We handle all surveillance, coordinate additional testing, and — when a tissue sample is needed — perform advanced diagnostic procedures right here in our practice.

We understand that waiting and watching can be stressful. Our team prioritizes clear communication at every step, so you always know where things stand, what the plan is, and what to expect next. No one should feel lost in the process of managing a lung nodule.

Robotic Bronchoscopy: A Minimally Invasive Path to Answers

When a nodule needs to be biopsied, the traditional approaches — CT-guided needle biopsy or surgical removal — both carry meaningful risks and limitations. CT-guided biopsy can cause a collapsed lung (pneumothorax) in a significant percentage of cases. Surgery is invasive and requires general anesthesia and recovery time.

PulmoCrit now offers robotic bronchoscopy using the Ion Endoluminal System, one of the most advanced minimally invasive tools available for lung nodule biopsy. The Ion system uses a flexible robotic catheter that can navigate deep into the peripheral lung — reaching nodules in areas of the lung that conventional bronchoscopes simply cannot access.

The benefits of robotic bronchoscopy for patients with lung nodules are significant:

• Minimally invasive — No cuts, no stitches. The procedure is performed entirely through the airways.
• Outpatient procedure — Most patients go home the same day.
• Access to peripheral nodules — The Ion system can reach nodules deep in the outer regions of the lung, where conventional tools fall short.
• Reduced complication risk — Compared to CT-guided needle biopsy, robotic bronchoscopy typically carries a lower risk of pneumothorax.
• Faster answers — Getting a tissue diagnosis sooner means earlier peace of mind — or earlier treatment if it turns out to be needed.

Robotic bronchoscopy isn't the right tool for every nodule — its benefits are greatest for nodules that are difficult to reach by other means. Your PulmoCrit pulmonologist will discuss whether it's the most appropriate approach for your specific situation.

When Is Lung Cancer Screening Right for You?

If you're between the ages of 50 and 80, have a significant smoking history (20 pack-years or more), and currently smoke or quit within the past 15 years, you may qualify for annual low-dose CT (LDCT) lung cancer screening. Lung cancer screening is designed to detect cancer at an early, more treatable stage — before symptoms develop.

The U.S. Preventive Services Task Force recommends annual LDCT screening for individuals who meet these criteria. If you're unsure whether you qualify, our team can walk you through the guidelines and help you decide if screening is right for you. Incidentally discovered nodules and screening-detected nodules are managed somewhat differently, and our pulmonologists are experienced with both.

What Should You Do If a Nodule Was Found?

If you've recently been told a pulmonary nodule was found on your imaging, the most important thing you can do is follow up with a pulmonologist — not just your primary care doctor. While your primary care physician plays an important role in your overall care, pulmonary nodule management involves nuanced decision-making that benefits from specialist expertise. Delays in follow-up are one of the most common reasons that early-stage lung cancers are caught later than they could have been.

At PulmoCrit, we make this process as easy as possible. Our lung nodule program is designed to keep you informed, supported, and moving through the right steps at the right time. Whether your nodule turns out to be completely benign or requires further evaluation, you'll have a clear plan and a team in your corner.