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Vincent Mase Jr., MD, pulmonologist Daniel Rudolph, MD, and Megin Iaccarino, APRN, lung cancer screening coordinator

Incidental lung nodules are frequently found on diagnostic exams and are now referred to the new Pulmonary Nodule Clinic at Smilow Cancer Hospital Care Center in Trumbull for follow-up. Here, Vincent Mase Jr., MD, site director of Bridgeport Hospital Thoracic Surgery (seated), reviews an image with Northeast Medical Group pulmonologist Daniel Rudolph, MD, and Megin Iaccarino, APRN, lung cancer screening coordinator.


Seeing spots? Incidental lung nodules get a closer look

Suppose you fell off a ladder and broke a rib. You go to the emergency department, and an X-ray reveals the fracture – and something else. Small spots on your lung found incidentally or by chance are now referred to the new Pulmonary Nodule Clinic at the Smilow Cancer Hospital Care Center in Trumbull for review and follow-up.

Pulmonary nodules are abnormal, round growths that are sometimes detected when a patient undergoes an X-ray or CT scan of the chest for an unrelated condition. While most nodules are not cancerous, some can be, making early diagnosis very important.

“Incidental nodules are found daily in up to 30 percent of diagnostic imaging exams,” said Megin Iaccarino, APRN, lung cancer screening coordinator at the Pulmonary Nodule Clinic. “Since the new clinic was launched in April 2022, we’ve had referrals from the emergency department, hospitalists, primary care physicians and self-referrals.”

Nodule follow-up

The biweekly clinic operates with the support of Vincent Mase Jr., MD, site director of Bridgeport Hospital Thoracic Surgery, and an assistant professor of surgery (thoracic surgery) at Yale School of Medicine; pulmonologist Daniel Rudolph, MD, a Northeast Medical Group physician; and diagnostic radiologist Christopher Gange, Jr., MD, an assistant professor of radiology and biomedical imaging at Yale School of Medicine.

When a referral comes in, Iaccarino reviews the patient’s imaging and medical history. She then follows up with the patient’s primary care physician, sends a radiology report and provides the team’s follow-up recommendations. “When patients come here, we do a very thorough respiratory background on them. We get their medical and family histories, do physical exams and provide a lot of patient education,” she said.

The team examines the size, shape and behavior of the nodule or how the nodule changes over time. “A nodule that is greater than 6 mm is most concerning, and it is followed closely,” Dr. Rudolph explained. All nodules are managed according to nationally recognized nodule management guidelines.

Risk factors for malignant nodules include age 50 and over, smoking history, family history of lung cancer, personal history of any type of cancer, and occupation, as environmental exposures can be important as well. Patients who smoke are offered smoking cessation counseling and other support.

Beyond incidentals

When Dr. Rudolph joined the Pulmonary Nodule Clinic in April, it was with an eye toward expanding services. “The intention was to expand the clinic to screen smokers for lung malignancies,” Dr. Rudolph said. “We can now evaluate these patients for follow-up, including other medical respiratory problems related to smoking.”

A thorough review of pulmonary lung nodules – whether found incidentally or through screening – has been a valuable service primary care physicians have long requested. “It really gives them peace of mind knowing that the patients they order scans on are going to get the follow-up they need,” Iaccarino said.

Learn more about services provided at the Pulmonary Nodule Clinic at Smilow Cancer Hospital Care Center in Trumbull, by calling 203-666-3524, or contacting Iaccarino at [email protected].