Pulmonary nodule

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Pulmonary nodule (also known as ” Solitary pulmonary nodule” or “SPN”) is defined as a relatively well defined round or oval pulmonary parenchymal lesion equal or smaller than 30 mm in diameter. Pulmonary nodule is usually surrounded by pulmonary parenchyma and/or visceral pleura and is not associated with lymphadenopathy, atelectasis, or pneumonia. Pulmonary nodule may be classified according to size (> 8 mm vs. ≤ 8 mm), attenuation (pure solid vs. part-solid), and distribution (solitary vs. multiple). It can also be classified into benign and malignant based on the radiological findings.Causes of pulmonary nodules can be classified into etiologies presenting with solitary or multiple lesions. Common causes of solitary pulmonary nodule include tuberculosis, primary lung cancer, granuloma, and rheumatic disease. Common causes of multiple pulmonary nodules include pulmonary neoplasms and tumor metastasis from other parts of the body. Pulmonary nodule may be differentiated according to imaging (size, border characteristics, and attenuation), histological, and clinical features, from other diseases that demonstrate similar imaging findings. Common differential diagnoses of pulmonary nodule include hamartoma, granulomas, rheumatoid nodule, and metastatic lesions. Pulmonary nodules are common. The estimated prevalence of incidental pulmonary nodule ranges between 0.09% to 7% in the general population. The incidence rate of pulmonary nodule increases with age, tobacco use, and prior cancer; the median age at diagnosis is between 35 to 70 years. The prevalence of malignancy among pulmonary nodules ranges between 0.2% to 50%. Males are more commonly affected with pulmonary nodule than females. The male to female ratio is approximately 2 to 1. There is no racial predilection to pulmonary nodule. According to the U.S. Preventive Services Task Force (USPSTF), screening for suspected lung cancer by low-dose computed tomography is recommended every year among smokers who are between 55 to 80 years old and who have smoking history of 30 pack years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation). A hallmark feature in the evaluation of pulmonary nodule is the malignancy risk assessment. The evaluation approach for pulmonary nodule will mainly depend in the initial morphological evaluation of the nodule (size, margins, contours, and growth). Other characteristics, such as location, clinical features, and distribution may be helpful in the risk assessment, management, surveillance, and follow-up of pulmonary nodule. Pulmonary nodule can be divided into 3 risk categories: low risk, intermediate/moderate, and high risk. Based upon these risk categories, complementary diagnostic studies and management include: PET/CT scan, CT scan, non-surgical biopsy, and surgical resection. Lung biopsy is the study of choice to diagnose pulmonary nodule. Biopsy for pulmonary nodule may be classified into 2 categories: non-surgical biopsy and surgical biopsy. Biopsy findings associated with pulmonary nodule will depend on tumor histology. Common types of lung tissue biopsy for solitary pulmonary nodule include conventional bronchoscopic-guided transbronchial biopsy, bronchoscopic–transbronchial needle aspiration, endobronchial ultrasound-guided sheath transbronchial biopsy, and endobronchial ultrasound-guided transbronchial needle aspiration. Common indications for biopsy in pulmonary nodule include: high risk nodule (> 65%), intermediate risk nodule with a high risk patient profile, intermediate risk nodule with a positive positron emission tomography scan. Pulmonary nodules are generally asymptomatic. In some cases, patients may develop non-specific symptoms, such as difficulty breathing, hemoptysis, chronic cough, wheezing, and chest pain. Obtaining a detailed history is an important aspect of making a diagnosis of solitary pulmonary nodule. Specific areas of focus when obtaining history include previous infection of tuberculosis, previous or current smoking history, history of immunological conditions, high occupational risk profession, or recent traveling. Patients with pulmonary nodule usually are well-appearing. Physical examination of patients with pulmonary nodule usually has no remarkable findings. In some cases, solitary pulmonary nodule may show findings associated with the underlying condition. There are no diagnostic laboratory findings associated with pulmonary nodule. There are no ECG findings associated with pulmonary nodule. On conventional radiography, characteristic findings of solitary pulmonary nodule include well-defined, small, and rounded opacities within the pulmonary interstitium, usually 8 mm in diameter and normally surrounded by normal aerated lung. There are no echocardiography/ultrasound findings associated with pulmonary nodule. CT scan is the method of choice for the diagnosis of solitary pulmonary nodule. On CT, characteristic findings of solitary pulmonary nodules include ground-glass opacity, rounded mass, and less than 30 mm in size. The evaluation of solitary pulmonary nodule will depend on the following characteristics: calcification pattern, size, location, growth, shape, margins, attenuation, and contrast enhancement. On MRI, characteristic features of pulmonary nodule include higher soft tissue contrast, lack of radiation exposure, lesion characterization by evaluation of signal intensities, and characterization of the dynamics of contrast uptake. Other imaging studies include PET/CT scanning, which may be useful as a staging modality, detection of occult disease, and malignancy assessment. Other diagnostic studies for solitary pulmonary nodule include transthoracic percutaneous fine needle aspiration, bronchoscopy, and mediastinoscopy. The optimal management approach of solitary pulmonary nodule mainly depends on the nodule size and growth. Other parameters, such as location and distribution may also be helpful. Surgical resection is often recommended among patients with a malignant likelihood of solitary pulmonary nodule. On the other hand, solitary pulmonary nodules with benign features are eligible for periodic CT surveillance. Surgical excision is the mainstay therapy for malignant or high risk pulmonary nodules. In pulmonary nodule, surgical procedure selection will depend on the size, margins, and size of the tumor. The preferred surgical procedure is wedge resection by video-assisted thoracic surgery and subsequent pathological evaluation. Primary prevention of solitary pulmonary nodule includes avoidance of active and passive smoking, exposure to asbestos, and high risk occupational jobs. The American College of Chest Physicians (ACCP) and Fleischner Society guidelines offer a strategy to manage and follow up on pulmonary nodule.

Pulmonary nodule may be classified according to size (> 8 mm vs. ≤ 8 mm), attenuation (pure solid vs. part-solid), and distribution (solitary vs. multiple). It can also be classified into benign and malignant based on the radiological findings.

Causes of pulmonary nodules can be classified into etiologies presenting with solitary or multiple lesions. Common causes of solitary pulmonary nodule include tuberculosis, primary lung cancer, granuloma, and rheumatic disease. Common causes of multiple pulmonary nodules include pulmonary neoplasms and tumor metastasis from other parts of the body.

Pulmonary nodule may be differentiated according to imaging (size, border characteristics, and attenuation), histological, and clinical features, from other diseases that demonstrate similar imaging findings. Common differential diagnoses of pulmonary nodule include hamartoma, granulomas, rheumatoid nodule, and metastatic lesions.

Pulmonary nodules are common. The estimated prevalence of incidental pulmonary nodule ranges between 0.09% to 7% in the general population. The incidence rate of pulmonary nodule increases with age, tobacco use, and prior cancer; the median age at diagnosis is between 35 to 70 years. The prevalence of malignancy among pulmonary nodules ranges between 0.2% to 50%. Males are more commonly affected with pulmonary nodule than females. The male to female ratio is approximately 2 to 1. There is no racial predilection to pulmonary nodule.

According to the U.S. Preventive Services Task Force (USPSTF), screening for suspected lung cancer by low-dose computed tomography is recommended every year among smokers who are between 55 to 80 years old and who have smoking history of 30 pack years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).

A hallmark feature in the evaluation of pulmonary nodule is the malignancy risk assessment. The evaluation approach for pulmonary nodule will mainly depend in the initial morphological evaluation of the nodule (size, margins, contours, and growth). Other characteristics, such as location, clinical features, and distribution may be helpful in the risk assessment, management, surveillance, and follow-up of pulmonary nodule. Pulmonary nodule can be divided into 3 risk categories: low risk, intermediate/moderate, and high risk. Based upon these risk categories, complementary diagnostic studies and management include: PET/CT scan, CT scan, non-surgical biopsy, and surgical resection.

Lung biopsy is the study of choice to diagnose pulmonary nodule. Biopsy for pulmonary nodule may be classified into 2 categories: non-surgical biopsy and surgical biopsy. Biopsy findings associated with pulmonary nodule will depend on tumor histology. Common types of lung tissue biopsy for solitary pulmonary nodule include conventional bronchoscopic-guided transbronchial biopsy, bronchoscopic–transbronchial needle aspiration, endobronchial ultrasound-guided sheath transbronchial biopsy, and endobronchial ultrasound-guided transbronchial needle aspiration. Common indications for biopsy in pulmonary nodule include: high risk nodule (> 65%), intermediate risk nodule with a high risk patient profile, intermediate risk nodule with a positive positron emission tomography scan.

Pulmonary nodules are generally asymptomatic. In some cases, patients may develop non-specific symptoms, such as difficulty breathing, hemoptysis, chronic cough, wheezing, and chest pain. Obtaining a detailed history is an important aspect of making a diagnosis of solitary pulmonary nodule. Specific areas of focus when obtaining history include previous infection of tuberculosis, previous or current smoking history, history of immunological conditions, high occupational risk profession, or recent traveling.

Patients with pulmonary nodule usually are well-appearing. Physical examination of patients with pulmonary nodule usually has no remarkable findings. In some cases, solitary pulmonary nodule may show findings associated with the underlying condition.

There are no diagnostic laboratory findings associated with pulmonary nodule.

There are no ECG findings associated with pulmonary nodule.

On conventional radiography, characteristic findings of solitary pulmonary nodule include well-defined, small, and rounded opacities within the pulmonary interstitium, usually 8 mm in diameter and normally surrounded by normal aerated lung.

There are no echocardiography/ultrasound findings associated with pulmonary nodule.

CT scan is the method of choice for the diagnosis of solitary pulmonary nodule. On CT, characteristic findings of solitary pulmonary nodules include ground-glass opacity, rounded mass, and less than 30 mm in size. The evaluation of solitary pulmonary nodule will depend on the following characteristics: calcification pattern, size, location, growth, shape, margins, attenuation, and contrast enhancement.

On MRI, characteristic features of pulmonary nodule include higher soft tissue contrast, lack of radiation exposure, lesion characterization by evaluation of signal intensities, and characterization of the dynamics of contrast uptake.

Other imaging studies include PET/CT scanning, which may be useful as a staging modality, detection of occult disease, and malignancy assessment.

Other diagnostic studies for solitary pulmonary nodule include transthoracic percutaneous fine needle aspiration, bronchoscopy, and mediastinoscopy.

The optimal management approach of solitary pulmonary nodule mainly depends on the nodule size and growth. Other parameters, such as location and distribution may also be helpful. Surgical resection is often recommended among patients with a malignant likelihood of solitary pulmonary nodule. On the other hand, solitary pulmonary nodules with benign features are eligible for periodic CT surveillance.

Surgical excision is the mainstay therapy for malignant or high risk pulmonary nodules. In pulmonary nodule, surgical procedure selection will depend on the size, margins, and size of the tumor. The preferred surgical procedure is wedge resection by video-assisted thoracic surgery and subsequent pathological evaluation.

Primary prevention of solitary pulmonary nodule includes avoidance of active and passive smoking, exposure to asbestos, and high risk occupational jobs.

The American College of Chest Physicians (ACCP) and Fleischner Society guidelines offer a strategy to manage and follow up on pulmonary nodule.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Joanna Ekabua, M.D. [2]

There is limited information about the historical perspective of pulmonary nodule

There is limited information about the historical perspective of pulmonary nodule

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Pulmonary nodule may be classified according to size (> 8 mm vs. ≤ 8 mm), attenuation (pure solid vs. part-solid), and distribution (solitary vs. multiple). It can also be classified into benign and malignant based on the radiological findings.

Pulmonary nodule may be classified according to size, attenuation, and distribution into the following:^[1]

• Nodules measuring >8 mm and < 30 mm in diameter
• Nodules measuring ≤8 mm in diameter

• Pure solid nodules
• Part-solid nodules

• Solitary pulmonary nodule
• Multiple pulmonary nodules

The table below summarizes the radiological features suggestive of benign or malignant pulmonary nodules.^[2]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Joanna Ekabua, M.D. [2]

The exact pathogenesis of pulmonary nodule is not fully understood.

The exact pathogenesis of pulmonary nodule is not fully understood.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2] Luke Rusowicz-Orazem, B.S.

Causes of pulmonary nodules can be classified into etiologies presenting with solitary or multiple lesions. Common causes of solitary pulmonary nodule include tuberculosis, primary lung cancer, granuloma, and rheumatic disease. Common causes of multiple pulmonary nodules include pulmonary neoplasms and tumor metastasis from other parts of the body.

• Causes of pulmonary nodules can be classified into etiologies presenting with solitary or multiple lesions.
• For details on the causes of solitary pulmonary nodule, click here.
• For details on the causes of multiple pulmonary nodules, click here.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2], Joanna Ekabua, M.D. [3], Maria Fernanda Villarreal, M.D. [4]

Pulmonary nodule may be differentiated according to imaging (size, border characteristics, and attenuation), histological, and clinical features, from other diseases that demonstrate similar imaging findings. Common differential diagnoses of pulmonary nodule include hamartoma, granulomas, rheumatoid nodule, and metastatic lesions.

• The table below summarizes the findings that differentiate pulmonary nodule from other conditions that cause similar radiological findings on CT scan of the chest.^[1][2]

ABBREVIATIONS:N/A: Not available , SOB: Shortness of breath, M/C: Most common
Diseases	Clinical manifestations							Para-clinical findings					Gold standard	Additional findings
	Symptoms						Physical exam
								Lab Findings	CT scan			Histopathology
	Productive cough	Hemoptysis	Weight loss	SOB	Fever	Other	Auscultation	Sputum analysis	Nodule	Nodule content	Other findings
Pulmonary Nodule(benign) [3]	–	–	–	–	–	N/A	Normal Pleural friction rub Egophony Crackling or bubbling Whispered pectoriloquy Absent breath sounds	Normal	Single Round, oval <5 mm nodule Ground glass	Fat Calcification Types: Central dense nidus Diffuse solid Laminated Popcorn	Well-defined smooth border Growth rate > 18 months Cavity wall thickness of 1 mm	N/A	N/A	↓ O2 Sat
Pulmonary Nodule (malignant) [3][4]	++	++	++	+	–	Recurrent pneumonia Wheezing Chest pain Cachexia Fatigue Anorexia Dysphonia Dysphagia	Normal Pleural friction rub Egophony Crackling or bubbling Whispered pectoriloquy Absent breath sounds	Tumor cells	Single or multiple Small or > 2 cm of size	Calcification Amorphous Punctate Reticular Stippled or eccentric Cavity Ulceration	Spiculated border Rapid growth rate (Doubling time 1-18 months) Cavity wall thickness over 15 mm	Central necrosis Cavity: Lined bycancer cells No necrosis	Biopsy and histopathology	↓ O2 Sat
Diseases	Productive cough	Hemoptysis	Weight loss	SOB	Fever	Other	Auscultation	Sputum analysis	Nodule	Content	Other findings	Histopathology	Gold standard	Additional findings
Abscess [5]	++	–	–	+	++	Pleuritic chest pain Foul smelling sputum Night sweats Fatigue	Decreased breath sound Bronchial breath sound Inspiratory crackles Localised crepitations	Causative agents	Vary in size Round in shape	Fluid/gas-fluid level Consolidation Cavity persists longer than consolidation	. The wall of the abscess is typically thick and the luminal surface is irregular Bronchial vessels and bronchi are truncated	Central necrotic tissue with necrotic granulocytes and bacteria Neutrophils Dilated blood vessels Inflammatory edema	Histopathology	Clubbing of finger
Septic pulmonary emboli [6]	–	–	–	++	++	Chest pain Primary infection (M/C right heart endocarditis)	Prominent P2 component of second heart sound Decreased breath sound Rales Crackles Pleural friction rub	N/A	Multiple peripheral nodules Size 0.5 – 3.5 cm Variable shapes	Central low attenuation Feeding vessels Pleura based wedge-shaped lesions	Air bronchogram Abscess or infection related changes at the primary focus	N/A	Culture and sensitivity	N/A
Fungal infection [7]	+/-	+	–	+	+	Chest pain Hypersensitivity Allergic reactions History of travel	Decreased breath sound Rales Crackles Pleural friction rub	KOH stain: Fungi	Multiple nodules Size 0.5 – 3 cm Nodules surrounded by ground-glass opacity/halo	Cavity	Halo sign in aspergillosis Patchy infiltrate Consolidation Mediastinal adenopathy	Causative agent	Culture and sensitivity	N/A
Parasites [8]	+/-	+/-	+/-	_	+	Asymptomatic Chest pain Pneumothorax Wheeze Urticaria Anaphylaxis (rarely)	Decreased breath sound Rales Crackles	N/A	Cysts: Single or multiple well-defined homogenous Coin lesion: 1 – 3 cm	Cyst: Fluid or gas Worm Coin lesion: Central necrotic Granulomatous reaction and fibrous wall	Calcified cyst wall Consolidation Pleural effusion Worm	Larvae or eggs	Visualization of parasite, egg or larvae	N/A
Diseases	Productive cough	Hemoptysis	Weight loss	SOB	Fever	Other	Auscultation	Sputum analysis	Nodule	Content	Other findings	Histopathology	Gold standard	Additional findings
Mycobacterial infections [9][10]	+	+	+	++	+/-	Chronic cough Night sweats Dyspnea Wheezing Cachexia Fatigue Loss of appetite	Decreased breath sounds Rales Rhonchi Bronchial breath sounds	AFB+	Micronodules in the subpleural region and peribronchovascular interstitium Fluffy upper zone shadowing Cavity	Superinfected cavities shows air-fluid level	Fluffy upper zone shadowing Interlobular septal thickening Homogeneous and dense consolidation	Granulomas: necrotizing/non-necrotizing Langhans giant cells Caseous necrosis	Culture and sensitivity	N/A
Chronic inflammatory conditions (Granulomatosis with polyangiitis) [11]	+/-	+	–	+	–	Hoarseness Chest pain Stridor	Pleural friction rub Absent breath sound Crackles	N/A	Multiple round lesions Size 0.5 – 10 cm	Patchy or diffuse ground-glass opacities, or both	Cavity Thick wall Irregular inner contour Atelectasis	Pathologic triad of granulomatous inflammation, vasculitis, and necrosis	Biopsy	c-ANCA p-ANCA
Diseases	Productive cough	Hemoptysis	Weight loss	SOB	Fever	Other	Auscultation	Sputum analysis	Nodule	Content	Other findings	Histopathology	Gold standard	Additional findings
Pulmonary AVMs [12]	–	+/-	–	+	–	Epistaxis Palpitation Chest pain GI bleeding Mucocutaneous telangiectasia	Bruit	RBCs	Solitary or multiple nodules Round, oval, or polycyclic Size 1 – 5 cm	Feeding pulmonary arteries and draining pulmonary veins	Well-defined borders Lower and middle third of the lung	Not done	Pulmonary angiography	Solitary rounded opacity on X-ray
Pneumoconiosis	+	–	+	+	–	Chest pain	Fine crackles Rhonchi Bronchial breath sounds Expiratory wheezing Egophony Bronchophony	Inorganic particle	Solitary or multiple nodules Size 1 – 10 cm In the upper lobes	N/A	Massive fibrosis or conglomerate masses Small nodular opacities Pleural plaques Lymphadenopathy, eggshell calcification	Calcification Central necrosis Dense collagen Malignant cells Ferruginous bodies	CT scan	N/A
ABBREVIATIONS:N/A: Not available , SOB: Shortness of breath, M/C: Most common

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Pulmonary nodules are common. The estimated prevalence of incidental pulmonary nodule ranges between 0.09% to 7% in the general population. The incidence rate of pulmonary nodule increases with age, tobacco use, and prior cancer; the median age at diagnosis is between 35 to 70 years. The prevalence of malignancy among pulmonary nodules ranges between 0.2% to 50%. Males are more commonly affected with pulmonary nodule than females. The male to female ratio is approximately 2 to 1. There is no racial predilection to pulmonary nodule.

• The incidence rate of pulmonary nodule increases with age, tobacco use, and prior cancer.^[1]

• The estimated prevalence of incidental pulmonary nodule ranges between 0.09% to 7% in the general population.^[1]
• The prevalence of malignancy among pulmonary nodules ranges between 0.2% to 50%.

• The median age at diagnosis is between 35 to 70 years.

• Males are more commonly affected with pulmonary nodule than females.
• .The male to female ratio is approximately 2 to 1.

• There is no racial predilection to pulmonary nodule.^[1]

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Joanna Ekabua, M.D. [2]

The most potent risk factor in the development of pulmonary nodule includes tobacco smoking, pack-years of smoking, age, occupational exposure to carcinogenic agents, previous history of lung cancer, family history of lung cancer, and comorbid chronic lung disease.

The most potent risk factor in the development of pulmonary nodule includes ^[1][2][3]

• Tobacco smoking
• Pack-years of smoking
• Age
• Occupational exposure to carcinogenic agents
  • Asbestos
  • Silica
  • Beryllium
  • Chromium
  • Arsenic
  • Nickel
  • Soot
  • Radon
  • Diesel fumes
  • Cadmium
• Previous history of lung cancer
• Family history of lung cancer
• Comorbid chronic lung disease

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

According to the U.S. Preventive Services Task Force (USPSTF), screening for suspected lung cancer by low-dose computed tomography is recommended every year among smokers who are between 55 to 80 years old and who have smoking history of 30 pack years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).

Guidelines

• According to the U.S. Preventive Services Task Force (USPSTF), screening for suspected lung cancer by low-dose computed tomography is recommended every year among smokers who are between 55 to 80 years old and who have smoking history of 30 pack years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).^{[1][2][3][4][5]}

• According to the clinical practice guideline issued by the American College of Chest Physicians (CHEST) in 2013, screening for suspected lung cancer by low-dose CT (LDCT) is recommended every year among smokers and former smokers who are 55 to 74 years old and who have smoked for 30 years or more and either continue to smoke or have quit within the past 15 years.^[6]

Strategies

• Low-dose helical computed tomography^[7]

• Benefits

• There is evidence that screening individuals aged 55 to 74 years who have smoking histories of 30 or more pack years and who, if they are former smokers, have quit within the last 15 years, reduces lung cancer mortality by 20% and all-cause mortality by 6.7%.

• Harms

• The majority of of all positive low-dose helical computed tomography screening exams do not result in a lung cancer diagnosis.
• False-positive exams may result in unnecessary invasive diagnostic procedures.

• Chest x-ray ^[8]

• Benefits

• Screening with chest x-ray does not reduce mortality from lung cancer in the general population or in ever-smokers.

• Harms

• False positive result
• The majority of of all positive chest x-ray screening exams do not result in a lung cancer diagnosis.
• False-positive exams result in unnecessary invasive diagnostic procedures.

Overdiagnosis

• Based on the current evidence, the majority of solitary pulmonary nodules detected by screening chest x-ray appear to represent overdiagnosed cancer.^[8]
• The magnitude of overdiagnosis appears to be between 5% and 25%.
• These cancers result in unnecessary diagnostic procedures and also lead to unnecessary treatment.
• Harms of diagnostic procedures and treatment occur most frequently among long-term and/or heavy smokers because of smoking-associated comorbidities that increase risk propagation.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Joanna Ekabua, M.D. [2]

If left untreated, 2% of patients with pulmonary nodule <8mm and >2% of patients with pulmonary nodule >8mm may progress to develop lung cancer.

Common complications of pulmonary nodule post invasive management include hemorrhage, [[pulmonary embolism], infections (empyema, pneumonia, surgical site), pleural effusions, pneumothorax, myocardial infarction and central neurological event

Prognosis is generally excellent which is dependent primarily on the characteristics of the pulmonary nodule. Pulmonary nodules are most commonly benign and may not necessarily require treatment. Those with multiple risk factors and malignant features on imaging studies have a poorer prognosis.

• The symptoms of pulmonary nodule usually develop in the third decade of life.
• A majority of pulmonary nodules are found incidentally. When symptomatic, patients display non-specific symptoms, such as difficulty breathing, hemoptysis, chronic cough, wheezing, and chest pain.
• If left untreated, 2% of patients with pulmonary nodule <8mm and >2% of patients with pulmonary nodule >8mm may progress to develop lung cancer.^[1][2]

• Common complications of pulmonary nodule post invasive management include:^[3][4]
• Hemorrhage
• Pulmonary embolism
• Infections (empyema, pneumonia, surgical site)
• Pleural effusions
• Pneumothorax
• Myocardial infarction
• Central neurological event

• Prognosis is generally excellent which is dependent primarily on the characteristics of the pulmonary nodule.
• Pulmonary nodules are most commonly benign and may not necessarily require treatment.
• Those with multiple risk factors and malignant features on imaging studies have a poorer prognosis.^[3][5]