Granulomas in the lungs are sometimes called granulomatous lung disease.
Lung granulomas can also be because of a severe disease but are usually not cancerous.
This article explains what lung granulomas are, including their possible symptoms and causes.
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It also covers how granulomas in the lungs are diagnosed and treated.
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.
This information is key to helping them narrow down whats causing your symptoms and the lung granulomas.
Most lung granulomas are not cancer (benign).
Possible causes of lung granulomas fall into a few categories.
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.
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.
Environmental Exposures
There are a number of environmental exposures that can lead to lung granulomas.
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.
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.
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).
Vasculitis
Vasculitisrefers to chronic inflammation of blood vessels.
There might be a single granuloma or multiple granulomas scattered throughout the lungs.
Other immune cells, includinglymphocytesand Langerhans cells, can also be involved.
Necrotizing granulomas are commonly associated with lung infections.
Since there are many possible causes, diagnosing granulomas in the lungs can be challenging.
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.
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.
In some cases, a chestmagnetic resonance imaging (MRI)scan is helpful.
Laboratory Tests
Some blood and lab tests can help diagnose the cause of lung granulomas.
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.
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.
This is done with help from either an ultrasound or a CT scan.
Endobronchial ultrasound-assisted biopsy/transbronchial biopsy
A biopsy can be done during anendobronchial ultrasound, referred to as a transbronchial biopsy.
Transbronchial biopsy uses forceps to take pieces of distal lung tissue to examine the alveoli.
Treatment
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.
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, its important to find out why you have them.
The underlying cause of lung granulomaslike a chronic health conditionmay need to be treated.
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