A mass in the lungs is most commonly found on X-rays and CTs of the chest. A mass in the lungs can represent many different diagnosis and does not necessarily mean cancer. A mass may require a biopsy for diagnosis.
What is a lung mass?
A lung mass is an opacification of the normally dark lung that measures greater then 3 centimeters in size. Less then 3 centimeters in size is called a nodule. A mass will look like a white area in the normally dark lung.
What could a mass in the lung be?
A lung mass is most commonly cancer but there are many other diagnosis that it could represent.
Infections with tuberculosis, fungus or other infecting organisms. A mass can be a lung abscess (collection of pus). Inflammation of blood vessels (vasculitis) can present as a mass.
Other benign and malignant tumors can present as a lung mass. Metastasis or spread of cancer from somewhere else can look like a mass.
Infarctions from clots to the lungs (pulmonary emboli can look like a lung mass).
Mimics of a mass include pneumonia or infection of the lung. A form of lung collapse called round atelectasis can mimic a mass.
Can imaging help us narrow the diagnosis?
The appearance of the mass and information about your history may allow the radiologist to provide a more narrow list of possibilities or even a specific diagnosis in some cases. Any old imaging you have will also help, particularly if the mass has been there for a long time.
Is a mass in the lung always cancer?
No, but cancer is most common and the main concern when we find a lung mass. We must exclude lung cancer in all cases as it is deadly and needs to be treated promptly.
Small vs large mass in the lung
A mass is defined as an abnormality of the lung greater then 3 centimeters. This along is large on X-rays and CTs. There is no definition of small versus large mass that is widely accepted. A small and large mass are both concerning for cancer. Regardless of the size, cancer will need to be excluded.
Lung mass symptoms
Cough sometimes with blood, chest pain or pressure, fatigue, swollen lymph nodes, hoarseness, weight loss
Mass in the lung on X-ray
A mass in the lungs on X-ray is seen as a white area greater then 3 centimeters in the normally dark lung. Many but not all masses will be seen on chest X-ray.
Most masses found on chest X-ray will be further evaluated with a chest CT. This is because most masses on chest X-ray will look the same regardless of the cause. A chest CT may help us make a diagnosis.
Mass in the lung on CT-scan
A chest CT is better then X-ray for getting a close look at a mass. We can sometimes make a diagnosis on chest CT other then lung cancer and spare the patient a workup. A chest CT will also help us find other abnormalities in the lung like additional nodules or enlarged lymph nodes.
Types of lung masses
-Spiculated lung mass
This is a mass that has edges that are irregular with spikes. This appearance becomes more concerning for cancer.
-Soft tissue mass
This is the most common appearance of a mass. This means that the internal consistency is that of a soft tissue growth. It is not a cyst filled with fluid, a mass filled with fat, or made of bone.
This appearance is non specific but most concerning when it occurs in the lungs. This means we usually don’t know what it is, but requires further workup to rule out cancer.
-Cavitating lung mass
This means the lung mass has air in it. Cancers, infections, pneumonias, infarcts, and other causes may have this appearance. This doesn’t necessarily help us reach a diagnosis.
What is done after a lung mass is found?
When a mass is found on chest X-ray, the next step often involves a chest CT. This will help look closer and determine what the cause may be. If the mass looks suspicious, a biopsy or a PET Scan may be recommended as our main concern is cancer.
Sometimes a lung collapse called round atelectasis can have the appearance of mass. A pneumonia can sometimes appear as a mass. In these cases, another follow up study may be recommended in several months to see if there has been resolution of the finding.
What if the mass turns out to be cancer?
Often a biopsy will be needed to diagnose cancer. Determining if the cancer has spread becomes important. This can be done with CTs of the rest of the body and PET scans.
What if the mass is not cancerous or we don’t know?
If the mass is not cancerous, follow up may still be indicated to make sure it does not grow.
When your mass turns out to be a pneumonia, it often gets smaller as the pneumonia is treated. The mass will have to be followed until it goes away to be safe as some pneumonias can be found with a cancer.
In all cases, you will need to follow the instructions of your doctor closely and get follow ups as needed.
Lung mass: summary
A lung mass is an abnormality greater then 3 centimeters in the lung. While we don’t know the exact diagnosis from imaging, we are most concerned about cancer. Often further workup will include CT, pet scan and possible biopsy. Care may involve multiple medical and surgical specialists.