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Differential diagnosis and evaluation of multiple pulmonary nodules

Jess Mandel, MD
Paul Stark, MD
Section Editors
Nestor L Muller, MD, PhD
Talmadge E King, Jr, MD
Deputy Editors
Geraldine Finlay, MD
Susanna I Lee, MD, PhD


The etiology of multiple pulmonary nodules can usually be determined with the help of a thorough history and physical examination. However, further testing is sometimes required for diagnosis, which may include imaging tests and/or a biopsy. The differential diagnosis and diagnostic evaluation of multiple pulmonary nodules are reviewed here. The approach to a solitary pulmonary nodule is discussed separately. (See "Diagnostic evaluation of the incidental pulmonary nodule".)


Malignant versus benign — Multiple pulmonary nodules may be caused by malignant or benign diseases.

In patients without a known primary malignant tumor, the following characteristics help differentiate multiple malignant nodules from multiple benign nodules:

Multiple pulmonary nodules that are ≥1 cm in diameter or detected by conventional chest radiography are most likely due to metastatic disease from a malignant solid organ primary tumor [1,2].

Multiple pulmonary nodules that are <5 mm in diameter, juxtaposed to either the visceral pleura or an interlobar fissure, and detected incidentally, are more likely to be benign lesions, such as granulomata, scars, or intrapulmonary lymph nodes [1-3].

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Literature review current through: Nov 2017. | This topic last updated: Nov 03, 2017.
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