These days a CAT scan of the chest is commonly used to work up chest pain, a persistent cough, or shortness of breath. There is even great interest in using CAT scan to find early lung cancers in current or former smokers. CAT scans identify abnormalities that chest x-rays cannot. For instance, the average lung cancer picked up by chest x-ray is over 2 centimeters in diameter whereas a CAT scan can show a tumor at 3 millimeters! Often however, it is unclear just what a “spot” discovered on a CAT scan really is.

Pulmonary nodules are one of the most common abnormalities identified on chest CAT scan. They are defined as “spots” less than 3 cm in diameter. They can be as harmless as old healed sites of infection or as deadly as beginning cancers. That is where the problem lies. Recently, smokers for more than 10 years were studied using chest CAT scans to find early cancers. Almost 25% of people studied had a nodule or nodules on a CAT scan, but less than 1 in 10 of those patients with a nodule were found to have lung cancer.

How does one figure out which nodules are harmless and which are deadly? These days that decision may involve a separate high tech picture called a PET scan. Other options include biopsies, repeat CAT scans, or surgery. By reviewing your medical history, exam, and the CAT scan, a lung doctor or pulmonologist can decide which nodules can be ignored, monitored over time, or quickly evaluated and possibly removed.

So if you are told that you have a “spot” on your lung, take a deep breath, and realize that you are one of 150,000 Americans told that each year. Then, ask if a pulmonologist may help in deciding what to do next.

Christian B. Lloyd MD., F.C.C.P.

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