Lung nodules are small dense spots seen on an X-ray or CT scan. Some are harmless, but others are caused by a variety of diseases including bacterial infections (e.g. tuberculosis), fungal infections (e.g. Aspergillus), cancer or some autoimmune diseases. Aspergillus nodules need long-term monitoring, but stable ones may not need any treatment
Symptoms are varied and can be difficult to distinguigh from those of other common lung conditions (e.g. CPA, COPD, bronchiectasis)
- Some people experience worrying nonspecific symptoms (e.g. cough, fever, weight loss, coughing up blood) and undergo testing for lung cancer, but then find out that it is ‘only’ a fungal infection. This can be a very scary and confusing time, so it may be helpful to join one of our patient support groups
- Stable (non-growing) nodules may not cause any symptoms at all – in fact, many people around the world carry one or more nodules without being aware
Nodules can develop as part of a more complex condition such as CPA, where there may be subtle deficiencies in the immune system that make a person more vulnerable to fungal pathogens
Nodules can also form in otherwise healthy people, when fungal spores are inhaled and the body forms a protective layer of ‘granulation tissue’ to contain the infection
Nodules are often first noticed on CT scans. Diagnosis can be tricky because sputum cultures and blood tests (e.g. Aspergillus IgG, precipitins) often return a negative result. Lung tissue can be sampled by doing a needle biopsy, which is then examined under a microscope to look for signs of Aspergillus. However, this procedure is quite invasive.
Not all nodules need antifungal treatment – your doctor may recommend a watch-and-wait approach in order to spare you the side-effects of these strong medications. If your nodule is growing, or new ones appear, then you may be given a course of antifungal medication such as voriconazole
Single nodules can occasionally be removed surgically, and then antifungals are given for some months to prevent recurrence
Unfortunately it is very difficult to predict how nodules will behave over time, especially in people where the underlying cause is not clear. Many nodules remain stable for many years and are simply monitored for changes. Some shrink, while others grow and new ones may appear. Some go on to develop a cavity filled with fungal debris (‘aspergilloma’) and some patients will eventually be diagnosed with CPA
Unfortunately there is very little information about fungal nodules available because it is such a rare and under-studied disease. Be very cautious about information you find online – there is a lot of misinformation on social media, which sometimes recommend unsafe diets and supplements.
NAC have published a scientific paper (www.ncbi.nlm.nih.gov/pmc/articles/PMC4991006) about Aspergillus nodules seen in our own clinic, which you can read online or share with your doctor.