What does a chest X-ray (CXR) showing noncalcified granulomas in the lungs indicate?

Interpretation of Your Chest X-Ray Report

Your chest X-ray shows small noncalcified granulomas that are most likely benign remnants of a prior infection (such as histoplasmosis or nontuberculous mycobacterial infection) and do not indicate active disease, active tuberculosis, or any communicable illness requiring treatment. 1, 2

What the Report Means

No Acute Disease (Points 1-2)

• No active cardiopulmonary disease: Your heart and lungs show no signs of current infection, fluid buildup, or other acute problems 1
• No active tuberculosis or communicable disease: You do not have TB or any infectious disease that could spread to others 1

The Granulomas (Point 3)

What are noncalcified granulomas?

• Granulomas are small collections of inflammatory cells that form when your immune system walls off something it perceives as foreign 3
• "Noncalcified" means they haven't developed calcium deposits yet, which typically happens over time as old granulomas heal 2
• Your granulomas are very small (3-4 mm), which strongly favors a benign cause 4

Most likely causes:

• Prior fungal infection (especially histoplasmosis): This accounts for the majority of unexplained pulmonary granulomas, particularly in endemic areas 2
• Prior nontuberculous mycobacterial infection: The second most common infectious cause 1, 2
• These represent "chronic sequela" (old scars) from infections that have already resolved, often without you even knowing you had them 1, 2

What You Should Do

Follow-up imaging:

• A repeat chest CT in 6-12 months is reasonable to document stability, especially since nodules <6 mm have less than 1% probability of malignancy 4
• If the granulomas remain unchanged in size, no further action is typically needed 2, 4

No treatment needed if:

• You have no symptoms (cough, fever, weight loss, night sweats) 1
• The nodules remain stable on follow-up imaging 2
• Studies show that patients with unexplained granulomas who remain asymptomatic have favorable outcomes without medical therapy (median follow-up 84 months) 2

When to be concerned:

• If nodules grow on follow-up imaging 4
• If you develop new respiratory symptoms 1
• If you have risk factors for lung cancer (smoking history, occupational exposures) that warrant closer surveillance 1, 4

Important Context

Why these are likely benign:

• Nodules <6 mm have <1% malignancy risk 4
• Multiple small granulomas in a random distribution are characteristic of prior granulomatous infection rather than cancer 5, 2
• At least 95% of all pulmonary nodules identified are benign, most often granulomas or lymph nodes 4
• In one large study of 131 completely resected necrotizing granulomas, infections (primarily histoplasmosis and nontuberculous mycobacteria) accounted for the majority of cases, and patients without a definitive diagnosis had excellent outcomes without treatment 2