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Fri, May 20, 2016 at 12:00 AM

What lung nodules are and what sneaky thing causes them

The high occurrence of ‘spots on the lung’ in Marshall County prompted Marshall Medical Centers to open a clinic to treat lung nodules one year ago so residents could get diagnosis and treatment within 48 hours of a diagnosis.

Dr. Chris Manganaris, a pulmonologist, recognized the need to start the Marshall Pulmonary Lung Nodule Clinic, giving sufferers somewhere to go locally.

So what are they?

A pulmonary nodule is a small, round growth of tissue in the lung. They can range in size from less than 1/5 inch (4 mm) to a little bigger than an inch (25 mm). Most pulmonary nodules are detected when imaging tests of the lung are being performed for a different problem. 

Are they dangerous?

Pulmonary nodules are usually not cancerous. Follow-up treatment or testing is based on the size of the pulmonary nodule and your risk of getting lung cancer. A thoracic surgeon cannot operate on a lung nodule smaller than 8 mm, which is less than half an inch. It takes months to double in size.  

What causes cancerous nodules?

The largest cause of cancerous nodules is smoking. Alabama and Marshall County in particular have more smokers than the national average. About 20 percent of local folks are addicted to tobacco. 

Malignant pulmonary nodules can result from lung cancer or from cancers that spread to the lung from other places in the body.

What causes benign nodules?

Benign pulmonary nodules can be caused by various things. Some of the causes include:

Bacterial, fungal, or viral infections. This is usually an old infection that is no longer active, but it can sometimes be a current, active infection.

A benign mass of tissue.

Inflammation from conditions such as rheumatoid arthritis.  

Abnormal blood vessels in the lungs.

An unexpected cause of lung nodules in Marshall County is the close proximity to where ducks and geese live—like Lake Guntersville.

Histoplasmosis, an infection that often causes lung nodules, is caused by breathing in spores of a fungus often found in bird and bat droppings. 

Histoplasmosis causes flu-like symptoms, including fever and cough. The body fights off the infection leaving scar tissue, which later shows up on an x-ray or CT scan as a lung nodule. 

“I’ve had to hospitalize several people for histoplasmosis,” Dr. Manganaris says. “It’s rare – less than 5 percent of people can't fight it off and require hospitalization and treatment.”

Dr. Manganaris estimates he sees about 10 cases a year of histoplasmosis in the hospital or clinic.

What is the treatment?

For cancerous nodules, Dr. Manganaris says most of the time the only cure is resection – removing a lobe of the lung.

“I had one patient lose an entire lung. He managed fine with only one lung. I’ve seen cancer in smokers as young as 25 years old.”

Dr. Manganaris includes counseling as part of the treatment at the clinic. Patients who are smokers get additional counseling aside from discussion about their pulmonary nodule diagnosis. 

Pulmonary nodules that are benign normally do not require any treatment because they usually don’t cause symptoms or breathing problems. But, they may be monitored with follow-up CT scans. The frequency of these CT scans will vary based on the size of the nodule and the risk factors for lung cancer

The Marshall Pulmonary Lung Nodule Clinic is located in the Marshall Professional Center, next to the Marshall Cancer Care Center. For more information call 256.894.6910 or click here.