Chest CT scan for the screening of air anomalies at risk of pulmonary barotrauma for the initial medical assessment of fitness to dive in a military population

Lung Granuloma: Symptoms, Causes, And Treatments

Granulomas are small lumps of immune cells that form in your body in areas where there is infection or inflammation. They're most commonly found in your lungs, but they can also be in other areas of your head and body. Doctors believe that they block the spread of organisms such as bacteria and fungi through your body.

Granulomas are usually accidentally found through X-rays or other tests when doctors look for other health issues. At first, they may look dangerous on imaging tests, but they're usually noncancerous.

Granulomas themselves don't usually have noticeable symptoms. But the conditions that cause them, such as sarcoidosis, tuberculosis, histoplasmosis, and others, may create symptoms. Some of these include:

In some cases, you may have lung granulomas that show no abnormal signs. They don't usually need treatment or other testing.

Reasons for granulomas in your lungs include:

Sarcoidosis. This is a disease that can affect your lungs and other organs. Researchers don't know the exact cause, but they think granulomas form when your immune system tries to fight off harmful infections, chemicals, or sometimes your body's own proteins. There's no cure, but you can usually manage it with little or no treatment.

Tuberculosis. A bacterium called Mycobacterium tuberculosis can attack the lungs and cause this disease. Granulomas can form in the lungs and stop the growth of the bacteria. But they can also allow bacteria to live and spread later.

Histoplasmosis. A fungus that is often found in bird and bat droppings can cause this lung infection if you breathe it in. Granulomas will form to stop the spread of the fungus. If you have histoplasmosis, you may never have symptoms. But for people with weak immune systems, it can be serious.

Granulomatosis with polyangiitis. This condition causes inflammation in your lungs and other parts of your body. It's a blood vessel disorder that slows down the flow of blood to your organs. Once this happens, the tissues around that area swell up and form granulomas. These granulomas can keep the affected organs from working properly.

Rheumatoid arthritis. This is an autoimmune disease that causes inflammation that can harm healthy cells. It can affect tissue all over your body.

Granulomas are usually found during a doctor's visit for something else. If your doctor thinks that you may have lung granulomas, they'll look at your medical history to see if there are any conditions that could cause inflammation. You may have to have a CAT scan or X-ray. These scans will show if your body has formed growths on your lungs.

In rare cases, a granuloma doesn't heal and the lung tissue around it can scar (pulmonary fibrosis). Or the air tubes in your lungs (bronchi) can form pockets and get infected. When this happens, there isn't a cure, but there are treatments that can ease your symptoms.

Granulomas on your lungs usually heal themselves and go away. The best way to control lung granulomas is to care for the health issues that cause them.

Lung Granulomas: What Do You Need To Know?

When lung tissue becomes inflamed from an infection or other cause, cells called histiocytes cluster to form nodules called granulomas. They may not cause any symptoms but may have an underlying cause that needs treatment.

Granulomas can form anywhere in your body but most commonly develop in your:

When granulomas first form, they're soft. Over time, they can harden and become calcified. This means calcium is forming deposits in the granulomas. The calcium deposits make these kinds of lung granulomas more easily seen on imaging tests, such as chest X-rays or CT scans.

On a chest X-ray, some lung granulomas can potentially look like cancerous growths. However, granulomas are noncancerous and often cause no symptoms or require treatment.

While lung granulomas usually have no symptoms, their underlying cause may present symptoms.

No symptoms (asymptomatic)

There are seldom symptoms associated with lung granulomas themselves. They may not be discovered until an X-ray or CT scan is taken. Lung granulomas with no abnormal symptoms may not need to be treated.

Common symptoms

If there are many granulomas or if they are located near the lung's airways, the symptoms may include:

coughs that don't go away

shortness of breath

chest pain

fever or chills

Symptoms related to underlying causes

Lung granulomas may form in response to respiratory conditions such as the following. In these cases, the underlying cause tends to present symptoms:

Sarcoidosis. When this inflammatory disease affects the lungs, symptoms may include a dry cough, shortness of breath, and wheezing.

Histoplasmosis. Symptoms of this lung infection include fever, dry cough, chest pain, and red bumps on your lower legs.

Tuberculosis. If this bacterial disease is in the lungs, symptoms may include a chronic cough, coughing up blood or phlegm, and chest pain.

Infections, inflammatory diseases, and other factors such as the following are associated with lung granulomas.

Infections

Infections that could cause granulomas include:

tuberculosis

nontuberculous mycobacteria (NTM), found naturally in water and soil, are among the more common sources of bacterial infections that lead to lung granulomas

fungal infections such as pulmonary coccidioidomycosis (valley fever) or cryptococcosis, which lives in soil with bird droppings

parasitic infections such as roundworms (ascariasis)

bacterial infections including aspiration pneumonia

Inflammatory granulomas

Lung granulomas may be caused by the following inflammatory conditions:

Granulomatosis with polyangiitis (GPA). This is a rare but serious type of vasculitis, inflammation of the blood vessels in your nose, throat, lungs, and kidneys. It's unclear why this develops, though it may be an abnormal immune system reaction to an infection.

Eosinophilic granulomatosis with polyangiitis (EGPA). Also known as Churg-Strauss syndrome, this is another type of vasculitis that may cause granulomas to form in the lungs.

Sarcoidosis. An inflammatory issue in which inflammatory cells can form clumps in various organs like the lungs.

Environmental causes

Exposure to environmental elements such as the following may cause lung granulomas:

an allergic reaction, called hypersensitivity pneumonitis, to substances such as mold or chemicals

exposure to dust from metals such as beryllium, aluminum, cobalt, or silica

using a hot tub may cause what's known as "hot tub lung" due to exposure to non-tuberculous mycobacteria (NTM)

medications such as methotrexate, Enbrel, and Humira

Autoimmune diseases

Autoimmune diseases such as the following, which occur when your immune system mistakenly attacks healthy cells in your body, may cause lung granulomas:

Rheumatoid arthritis (RA). Lung granulomas, also referred to as rheumatoid or lung nodules, occur in 20 percent of people with RA, a condition that causes joint pain and inflammation. They are usually harmless, but there's a small risk that they can burst and harm your lung.

Sjögren's syndrome. Lung granulomas may occur with this condition that mostly affects the salivary and lacrimal glands, preventing your body from producing enough saliva and tears.

Inflammatory bowel disease (IBD). According to a 2019 study, up to 36 percent of people with IBD had granulomas in their lungs or organs other than their gastrointestinal tracts.

Related to cancer

People with leukemia may develop lung granulomas due to lymphomatoid granulmatosis, a rare condition caused by the overproduction of lymphocytes, or white blood cells.

Immunodeficiency

Chronic granulomatous disease (CGD). This rare, inherited condition affects certain white blood cells, causing inflammation and preventing your immune system from fighting bacterial and fungal infections.

Granulomatous–lymphocytic interstitial lung disease (GLILD). This is a severe complication of CVID that can cause the long-term loss of respiratory function.

Other

Another condition that may cause lung granulomas is pulmonary Langerhans cell histiocytosis (PLCH), a rare lung disease whose cause isn't known. It most often affects adults who smoke cigarettes.

To diagnose lung granulomas and determine whether they are cancerous, your doctor will perform a physical exam and a variety of tests.

History and physical exam

Your doctor will first ask you about your symptoms, such as when they started.

You may be asked about any other illnesses you have, your travel history, and exposure to certain environmental factors where you live and work.

Imaging tests

Because they're small and usually cause no symptoms, granulomas are often discovered accidentally.

For example, if you're having a routine chest X-ray or CT scan because of a respiratory problem, your doctor may discover small spots on your lungs that turn out to be granulomas. If they're calcified, they're especially easy to see on an X-ray.

At first look, granulomas resemble possibly cancerous tumors. A CT scan can detect smaller nodules and provide a more detailed view.

Cancerous lung nodules tend to be more irregularly shaped and larger than benign granulomas, which generally are up to 10 millimeters in diameter. Nodules higher up in your lungs are also more likely to be cancerous tumors.

If your doctor sees what appears to be a small and harmless granuloma on an X-ray or CT scan, they may monitor it for a while, taking additional images over a period of years to see if it grows.

Laboratory tests

To help determine the cause of your lung granuloma, your doctor may order laboratory tests such as the following:

Complete blood count (CBC). A high number of white blood cells could indicate an infection.

Serology. This type of blood test finds antibodies in your blood that can indicate a fungal, bacterial, or other type of infection.

Tuberculosis testing. A purified protein derivative (PPD) skin test can determine if someone may have been exposed to tuberculosis.

Procedures

Procedures such as the following may be done to examine the lung granuloma:

Bronchoscopy. After you're given relaxing medication, a thin tube called a bronchoscope that has a light and camera is inserted through your nose or mouth and down your throat to your lungs.

Bronchoalveolar lavage. During a bronchoscopy, sterile saline may be injected in your lungs. A sample of cells is then suctioned out and examined under a microscope to detect hypersensitivity pneumonitis.

Endobronchial ultrasound. During a bronchoscopy, an ultrasound probe attached to the bronchoscope enables your doctor to see areas of your lungs.

Biopsy

Your doctor may also take a biopsy of a lung granuloma to determine if it's cancerous. A biopsy involves removing a small piece of suspicious tissue with a bronchoscope or a thin needle.

The tissue sample is then examined under a microscope.

Other testing

Pulmonary function tests (PFTs), breathing tests that measure how efficiently air moves in and out of your lungs, may also be recommended by your doctor.

A larger granuloma may be evaluated over time using lung positron emission tomography (PET) scans. This type of imaging uses the injection of a radioactive substance to identify areas of inflammation or malignancy.

Lung granulomas typically don't require treatment, especially if you have no symptoms.

Because granulomas are usually the result of a diagnosable condition, treatment of the underlying condition is important.

For example, a bacterial infection in your lungs that triggers granuloma growth should be treated with antibiotics. An inflammatory condition, such as sarcoidosis, may be treated with corticosteroids or other anti-inflammatory medications.

Once you have the underlying cause of lung granulomas under control, you may not have additional nodules form in your lungs.

Some conditions, such as sarcoidosis, have no cure, but can be fairly well managed. While you may keep inflammation levels down, it's possible more granulomas may form.

Lung granulomas and other growths in your lungs are usually identified when your doctor is looking for other respiratory problems. That means it's important to report symptoms such as coughing, shortness of breath, and chest pain promptly to your doctor.

The sooner you have symptoms evaluated and diagnosed, the sooner you can get helpful treatment.

What Do Calcified Granulomas In The Lungs Mean?

A calcified granuloma in the lung is a cluster of immune cells with calcium deposits. They can be asymptomatic or cause symptoms such as wheezing and chest pain.

A granuloma is a small cluster of white blood cells and tissues. Granulomas can form in the lungs, as well as other areas of the body, such as the head, skin, or liver.

Granulomas are benign and not cancerous. Inflammation, infections, or foreign objects may cause granulomas to form.

Sometimes, a granuloma may calcify. This means calcium deposits collect in the granuloma, causing it to harden.

This article looks at the symptoms, causes, diagnosis, treatment, and outlook for calcified granulomas in the lungs.

Typically, granulomas do not cause any symptoms.

However, some calcified granulomas in the lungs may cause symptoms, but this depends on the underlying cause. Some symptoms may include:

Non-infectious diseases which may cause lung granulomas include:

Rarely, immunotherapy drugs cause granulomas. One such case study reports the drug pembrolizumab reactivating a lung granuloma.

According to a 2021 article, calcification of a granuloma may occur if the granuloma has extensive fibrosis. Fibrosis is a scarring or thickening of tissue.

In rare cases, calcified lung granulomas may occur with pneumocystis jirovecii pneumonia (PJP), a type of pneumonia from fungi.

Can COVID-19 cause granulomas?

According to a 2021 article, the SARS-CoV-2 virus may trigger certain responses in the body, which cause granulomas to form.

The research suggests that granulomas may form due to the body's effective response to COVID-19 to prevent severe or life threatening illness.

A 2022 case report and review notes a case study in which a person who had recovered from severe COVID-19 infection developed sarcoidosis, which causes granulomas to form in the lungs and lymph nodes.

The research suggests that changes in the immune system play a role in the two conditions.

Any factors or conditions that increase the risk of infections or can cause granulomas may increase the risk of calcified lung granulomas.

For example, sarcoidosis is an inflammatory condition that causes granulomas to form in the lungs and chest lymph nodes. Risk factors for sarcoidosis include:

being older than 55 years

working with insecticides, mold, or substances that may cause inflammation

having a family history of sarcoidosis

taking certain HIV medications or monoclonal antibodies

being of African or Scandinavian descent

being female

According to older research from 2010, TB is a common cause of calcified granulomas in the chest, including in the lungs.

close contact with a person with TB

a weakened immune system

Exposure to non-tuberculous mycobacteria (NTM) is a risk factor for lung granulomas.

Mycobacteria can occur in soil and water. Factors that may increase the risk of a mycobacterial infection include:

To diagnose calcified lung granulomas and differentiate them from other conditions, doctors may carry out the following:

Calcified granulomas are benign and often do not cause symptoms, so not all will require treatment. However, a doctor may need to treat the trigger or underlying cause of the granulomas.

Although granulomas may have similarities to cancerous growths on imaging scans, the Journal of Thoracic Disease states that calcification of a lung nodule usually indicates a benign growth.

Treatment and recovery time may depend on the underlying cause and the presence of symptoms. Treatment may help prevent complications, such as breathing difficulties or lung damage.

Calcified granulomas in the lungs are clusters of immune cells which contain calcium deposits. Infections, inflammation, or foreign objects may lead to calcified lung granulomas.

Calcified lung granulomas are benign, but sometimes, they cause scarring of the lungs or breathing problems.

Treatment can help to treat the underlying infection or inflammation and help prevent complications.

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