Solitary Pulmonary Nodule Clinical Presentation

Updated: Aug 22, 2019
  • Author: Pujan H Patel, MD; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
  • Print
Presentation

History

Most patients with solitary pulmonary nodules are asymptomatic; the nodules are typically detected as an incidental finding. Approximately 20-30% of all bronchogenic carcinomas appear as solitary pulmonary nodules on initial radiographs. The following features are important when assessing whether the nodule is benign or malignant [7] :

  • History of malignancy

  • History of smoking & pack-years smoked

  • Occupational risk factors for lung cancer - Exposure to asbestos, radon, nickel, chromium, vinyl chloride, and polycyclic hydrocarbons can lead to the development of a solitary pulmonary nodule

  • Travel to areas with endemic mycosis (eg, histoplasmosis, coccidioidomycosis, blastomycosis) or with a high prevalence of TB 

  • History of TB or pulmonary mycosis

Next:

Physical Examination

While there are no specific physical findings for patient's with a lung nodule, the clinical presentation varies depending on the location of the tumor (eg, trachea, other airways, parenchyma). The following symptoms may be appreciated on physical examination:

  • Pseudoasthmatic (localized) wheezing

  • Persistent coughing

  • Hemoptysis

  • Fever - Especially when associated pneumonia is present

  • Diminished breath sounds

  • Dullness to percussion

  • Rales

  • Digital clubbing

  • Autoimmune disease–associated skin and joint abnormalities

Most patients are asymptomatic from their solitary pulmonary nodules. If a patient is asymptomatic, the tumor is typically identified serendipitously. [7]

Previous