Should I be concerned about scattered pulmonary nodules, including a 1.1 cm spiculated nodule in the right middle lobe and a 1.0 cm spiculated nodule with surrounding tree-in-bud nodularity in the right upper lobe?

From the Guidelines

You should be concerned about these pulmonary nodules and seek prompt medical evaluation. The presence of spiculated (irregular, star-shaped) nodules measuring 1.0-1.1 cm in your lungs requires follow-up, as these characteristics can sometimes indicate malignancy, as suggested by the study published in the Journal of the American College of Radiology in 2023 1. The tree-in-bud nodularity surrounding one nodule could suggest an inflammatory or infectious process, which is supported by the findings of a study published in Chest in 2006 1.

Some key points to consider:

• The size and morphology of the nodules are important factors in determining the likelihood of malignancy, as discussed in the study published in Chest in 2013 1.
• The Fleischner Society guidelines provide a framework for managing incidental pulmonary nodules, but the management of pure ground glass nodules is still not well established, as noted in the study published in the Journal of the National Comprehensive Cancer Network in 2012 1.
• A multidisciplinary team approach is recommended for the management of patients with pulmonary nodules, as suggested by the study published in the Journal of the National Comprehensive Cancer Network in 2012 1.

You should schedule an appointment with a pulmonologist as soon as possible. They will likely recommend additional testing such as a PET scan, contrast-enhanced CT, or possibly a biopsy to determine the nature of these nodules. While many pulmonary nodules turn out to be benign, the spiculated appearance and size of yours warrant thorough investigation. The doctor may also review your risk factors including smoking history, occupational exposures, and family history of lung disease. Try not to panic while awaiting evaluation, as even concerning-appearing nodules can have non-cancerous causes, but do prioritize getting this assessed promptly, as recommended by the study published in the Journal of the American College of Radiology in 2023 1.

From the Research

Pulmonary Nodules and Tree-in-Bud Pattern

• The presence of scattered pulmonary nodules, including a 1.1 cm right middle lobe spiculated nodule and a 1.0 cm right upper lobe spiculated nodule with surrounding tree-in-bud nodularity, may indicate a need for further evaluation 2.
• The tree-in-bud pattern on chest CT can reflect bronchiolar mucoid impaction and is often associated with infectious causes, but can also be seen in non-infectious conditions such as malignancy or immunological disorders 3, 4.
• The detection of pulmonary nodules can be improved with high-resolution reformatted images from PET/CT studies, which can increase the sensitivity for nodule detection and approach that of dedicated breath-hold CT 5.

Management and Follow-up

• The management of pulmonary nodules requires a clear algorithm for description, management, and follow-up, taking into account the potential for benign or malignant conditions 2.
• The presence of spiculated nodules and tree-in-bud pattern may indicate a need for closer monitoring or further diagnostic evaluation, such as bronchoscopy or biopsy, to determine the underlying cause 2, 3, 4.

Diagnostic Evaluation

• High-resolution computed tomography (HRCT) is an important diagnostic instrument in pneumology and can help identify the tree-in-bud sign and other patterns associated with pulmonary nodules 3, 4.
• The use of PET/CT studies with high-resolution reformatted images can improve the detection of pulmonary nodules and help guide further diagnostic evaluation 5.