Lung Nodules: What They Are, When To Worry and How To Lower Your Risk

Picture this: Your doctor orders an imaging test like a chest X-ray in preparation for an upcoming procedure, and the results show a small white spot in the center of your lungs—a pulmonary or lung nodule. Suddenly, you’re wondering what this means for your health. Should you be concerned? Here, doctors explain when to worry about lung nodules, symptoms to look for plus how to prevent them in the first place.

What are lung nodules?

“A lung nodule is a small, solid, rounded mass of tissue in the lungs that can be seen on a chest computed tomography (CT) scan or X-ray as a white spot,” explains Samir Shah, MD, an interventional radiologist and Chief Medical Officer at Qure.ai. 

Pulmonary nodules typically form when a bacterial or viral infection irritates the lung tissue. This causes a small clump of cells called a granuloma to form. The nodules can also be caused by air pollution, fungal infections and autoimmune diseases like rheumatoid arthritis (RA).

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But is a lung nodule something to worry about? First, the good news. About 95 percent of lung nodules are benign or noncancerous and nothing to worry about. Still, pulmonary nodules shouldn’t be ignored.

“One of our most important jobs is figuring out which nodules require further attention and which ones don’t,” says Scott Oh, DO, co-director of UCLA interventional pulmonology and clinical professor of medicine at the David Geffen School of Medicine at UCLA.

Symptoms of lung nodules

Considering the location of the nodules, you might assume they present an array of side effects. However, most lung nodules present no symptoms, says Steven Davis, MD, an associate professor of internal medicine at the Burnett School of Medicine at TCU. 

“If [a nodule] is large and close enough to an airway to block it off, a patient might experience shortness of breath or a cough,” he notes. “And, if it’s related to active pneumonia, symptoms could include fever, chills and a cough or shortness of breath.” 

But these manifestations are the exception, not the rule. Studies show 95 percent of lung nodules are asymptomatic.

How are lung nodules diagnosed? 

Because lung nodules rarely present symptoms, Dr. Shah says they’re often detected unintentionally “when medical imaging is done for other reasons.” For example, your doctor might notice a lung nodule while taking chest X-rays or CT scans for pneumonia or other issues. 

Dr. Davis echoes this insight, adding that CT scans are generally more effective at identifying lung nodules than X-rays. Since X-rays provide lower-resolution images, Dr. Davis says they can only detect larger nodules. CT scans, on the other hand, produce more detailed photos and are better at identifying lung nodules of all sizes.  

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When to worry about lung nodules

Most lung nodules benefit from a “wait and watch” approach, according to Dr. Oh. Routine monitoring with CT scans can check for growth and other changes that might indicate the nodule is cancerous.

That said, you might worry more about lung nodules if you have certain risk factors. “For example, a patient in their 60s with a history of smoking-related emphysema and a first-degree relative with lung cancer is at higher risk than someone in their 20s who has never smoked,” Dr. Oh explains. “Several [other] factors can [also] confer a higher level of concern, including the size, density and borders of the lung nodule, its location and if it changes over time.” 

If you have a history of lung disease, your healthcare provider may order additional tests like bloodwork or a lung biopsy to determine your risk of lung cancer and guide your treatment plan.

How to reduce your risk of lung nodules

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The experts we interviewed say there’s no way to prevent lung nodules entirely, but you can reduce your risk by taking good care of your respiratory health. Obviously, if you smoke you should strive to quit—but avoiding exposure to air pollution and infections helps reduce the risk of lung nodules, too. Staying current on your vaccines and wearing an N-95 mask in crowded places or when there’s poor air quality can help support these efforts.

A lung cancer screening is also beneficial. Dr. Oh says the United States Preventive Services Task Force encourages you to undergo lung cancer screening if you:

• Are 50-80 years old
• Have a history of smoking for at least 20 pack-years (e.g., one pack per day for 20 years, or two packs per day for 10 years)
• Currently smoke or quit smoking in the last 15 years

“Finding [lung] nodules, figuring out which ones are cancer and getting them treated as early as possible are critical to improving lung cancer outcomes,” Dr. Oh assures. “Please get screened if you qualify, and if you have a nodule that is incidentally detected, get it evaluated.”