Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
This article explains what lung granulomas are, including their possible symptoms and causes. It also covers how granulomas in the lungs are diagnosed and treated.
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Lung Granuloma Symptoms
The signs and symptoms of lung granulomas range from none to widespread symptoms related to their underlying cause.
Asymptomatic vs. Symptomatic Granulomas
Many lung granulomas are found accidentally during a chest X-ray for another medical problem. In these cases, the condition may not cause symptoms (asymptomatic) but may still need medical treatment.
Granulomas in the lungs do not usually cause symptoms on their own, but there are exceptions. For example, if the granulomas are near the large airways of the lung or if there are a lot of granulomas, it’s more likely that they will cause cough, wheezing,shortness of breath, or recurrent respiratory infections.
Granulomatous lung disease can also be associated with other lung diseases (such asinterstitial pneumonia) that cause respiratory symptoms.
Symptoms Related to the Underlying Cause
Symptoms of lung granulomas are more often related to the condition that is causing them:
Your provider will need to know about all the symptoms you’re having, even if they seem vague (like general fatigue). This information is key to helping them narrow down what’s causing your symptoms and the lung granulomas.
Causes of Lung Granulomas
Lung granulomas are usually related to a normal body process where the immune system tries to contain a foreign substance in the lungs. This might be a microorganism, pieces of inhaled metals or toxins, or damaged tissues from inflammatory orautoimmune diseases.
Most lung granulomas are not cancer (benign). Possible causes of lung granulomas fall into a few categories.
The Best and Worst Foods for Healthy Lungs
Lung Infections
Infections are the most common cause of granulomas.
Tuberculosis
Worldwide,tuberculosisis a common cause of pulmonary granulomas.
Non-Tubercular Mycobacterium
Mycobacterial infections such asMycobacterium aviumcomplex andMycobacterium kansasiican also cause granulomatous lung disease.
Fungal Infections
There are more than 140 types of fungal infections that can cause lung granulomas, the most common being:
Parasitic Infections
Parasitic infections as a less common cause of lung granulomas in the U.S., but include:
Bacterial Infections
Bacterial infections are not common causes of lung granulomas but when they do occur, they are often from:
Inflammatory Conditions
Inflammatory conditions can cause lung granulomas because they put the body under a great deal of inflammation.
Sarcoidosis
Sarcoidosisis an inflammatory disease that can affect many parts of the body. It often starts with symptoms like swollen glands, skin changes, fatigue, and joint pain and swelling.
Bronchocentric Granulomatosis
Bronchocentric granulomatosisis an inflammatory condition that affects the smaller airways of the lungs (bronchioles). It is thought to be a response to an injury to the lungs.
Inflammatory Bowel Disease
Withinflammatory bowel diseases (IBD)such as Crohn’s disease and ulcerative colitis, granulomas may occur not only in the gastrointestinal (GI) tract but in other parts of the body such as the lungs. In one study, 21% to 36% of people had evidence of lung granulomas outside of the GI tract.
Environmental Exposures
There are a number of environmental exposures that can lead to lung granulomas.
Hypersensitivity Pneumonitis
Toxic Metal Exposure
Exposure to the metalberyllium(which is used in industrial ceramic manufacturing) can lead to a condition calledberylliosis. Other metal dust exposures can cause symptoms similar to berylliosis.
Metal exposures to be aware of include aluminum, titanium, silica, zirconium, cobalt, and silica.
Talc granulomas are most often related to illicit drug use. This condition is usually seen with the injection of crushed-up pills (such as opiates, barbiturates, andmethylphenidate) that release excess talc into the bloodstream.
Medications
Adverse reactions to medications have also been linked to lung granulomas. Some of the drugs are actually used to treat medical conditions that are associated with pulmonary granulomas.
Medications that are linked to granulomas in the lungs include:
Autoimmune Diseases
Lung granulomas can also form in people with autoimmune diseases.
Rheumatoid Arthritis
Necrotizing granulomas are relatively common in people withrheumatoid arthritis(RA). They may occur in the lungs as well as under the skin (subcutaneous). The granulomas can be related to the underlying disease or be an adverse reaction to medications used to treat the disease.
Sjögren’s Disease
A number of lung problems, including lung granulomas, are associated withSjögren’s disease, an autoimmune disease targeting the body’s moisture-producing tissues.
Vasculitis
Vasculitisrefers to chronic inflammation of blood vessels. This condition can occur in blood vessels anywhere in the body, but the most common places are the lungs and kidneys.
Types of vasculitis associated with granulomas include:
Granulomatous Lymphocytic Interstitial Lung Disease
Granulomatous lymphocytic interstitial lung disease(GLILD) is a rare and potentially severe lung complication associated with immunodeficiency. It affects the tissues around the air sacs in the lungs (alveoli) and causes scarring and thickening of tissues.
GLILD can also be secondary to an autoimmune disease or the result of a certain type of pneumonia that affects these tissues.
Recurrent Respiratory Infections in Adults
Cancer
Granulomas in the lungs are usually associated with non-cancerous conditions, but can also be seen with some cancers:
A lung granuloma is often first seen on a chest X-ray as alung nodule. There might be a single granuloma or multiple granulomas scattered throughout the lungs.
Under a microscope, a granuloma is made up of immune cells calledmacrophagesthat surround and neutralize the foreign agent in the frontlineimmune defense. Other immune cells, includinglymphocytesand Langerhans cells, can also be involved.
Granulomas might only be in the lungs but can also affect other parts of the body, such as the skin and lymph nodes, based on the underlying cause.
There are also granulomas known as “necrotizing granulomas” in which cell death (necrosis) occurs around the area of inflammation. Necrotizing granulomas are commonly associated with lung infections.
Since there are many possible causes, diagnosing granulomas in the lungs can be challenging. In addition to a careful history and physical exam, lab tests, imaging tests, pulmonary function testing, and a lung biopsy might also be needed.
History and Physical Exam
The diagnosis of a granuloma in the lung begins with a careful history of your symptoms, including those that do not have to do with your lungs. When symptoms are present, it’s important to note whether they came on recently (acute) or have been ongoing (chronic).
Where you live is also helpful in narrowing down possible fungal causes, as well as a history of travel. On-the-job exposures (such as to beryllium) should also be noted.
A history of repeated infections (such as sinusitis) is often noted in people with immunodeficiency. Since immunodeficiency syndromes are a cause of repeated infections in both adults and children, it’s important to let your healthcare provider know if you’ve had repeated sinus or other respiratory tract infections.
Recurrent Respiratory Infections in Children
Imaging Studies
A lung granuloma or granulomas are often first spotted when a chest X-ray orchest computed tomography (CT)scan is done for another reason.
A high-resolution chest CT scan is a very important step in the diagnosis and evaluation of a lung granuloma. Calcium deposits in granulomas often make them visible on these scans.
For people who have had a lower-resolution CT scan (such as those done for lung cancer screening), a high-resolution scan should also be done. In some cases, a chestmagnetic resonance imaging (MRI)scan is helpful.
Apositron emission tomography (PET)scan is often done to check for cancer, vasculitis, and inflammatory diseases. However, the rate of false positives (indicating a person has a condition when they really do not) is high with this test.
Laboratory Tests
Some blood and lab tests can help diagnose the cause of lung granulomas.
How Tuberculosis is Diagnosed
Procedures
There are non-invasive and invasive procedures used to see inside the lungs and look for granulomas.
Bronchoscopy
Abronchoscopycan be used to directly visualize the airways. In a bronchoscopy, a flexible tube is inserted through the mouth and threaded down to the large airways of the lungs.
Endobronchial Ultrasound
An ultrasound probe can be attached to a bronchoscope to allow providers to see regions in the lungs near the airways. With special tools, a biopsy can also be done to take out granulomatous tissues near the airways.
Bronchoalveolar Lavage
Bronchoalveolar lavagecan be done during a bronchoscopy to help diagnose hypersensitivity pneumonitis.
During the procedure, sterile saline is injected into the lungs through the bronchoscope and then suctioned out. The extracted cells can then be examined under a microscope.
Biopsy
A biopsy specimen is often needed to determine or confirm the cause of a lung granuloma. Alung biopsyspecimen can be obtained in several ways.
Fine Needle Aspiration Biopsy
Endobronchial ultrasound-assisted biopsy/transbronchial biopsy
A biopsy can be done during anendobronchial ultrasound, referred to as a transbronchial biopsy. Withsarcoidosis, a transbronchial biopsy combined with a PET scan has replaced a more invasive procedure known asmediastinoscopy, which requires access through an incision in the chest wall.
Transbronchial biopsy uses forceps to take pieces of distal lung tissue to examine the alveoli.
Surgical Lung Biopsy
If an FNA or transbronchial biopsy does not provide a large enough sample, surgery might be needed. This can involve either video-assisted thoracoscopic surgery (VATS) that uses just a few small incisions with specialized instruments, or open lung surgery (thoracotomy).
The treatment of lung granulomas will depend on the underlying cause. In general, most granulomas do not need to be surgically removed. Exceptions are if the granuloma or granulomas are causing symptoms or if the diagnosis is uncertain.
These are some potential treatments for granulomas in the lungs:
Summary
Lung granulomas form on the lungs usually after an infection or because of inflammation. Often, they do not cause symptoms. Some people first find out they have lung granulomas when undergoing a scan that looks at their chest. While treatment may not be needed, it’s important to find out why you have them. The underlying cause of lung granulomas—like a chronic health condition—may need to be treated.
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