Lung Scarring: Is Removal Necessary?

Small areas of lung scarring typically aren’t serious. They shouldn’t affect your quality of life or life expectancy.

That said, widespread and expanding scars on the lung may indicate an underlying health condition. This underlying condition may affect your quality of life and overall health. In these cases, your doctor will determine the source of the scarring and deal with it directly.

In extreme cases of lung scarring, doctors may have to surgically replace the lung. This is known as a lung transplant.

Removing a scar directly isn’t an option. Instead, your doctor will assess the scarring and determine whether any further steps are needed.

Your doctor will use X-ray images to assess the size and stability of the scarring. They’ll also check to see if the scar is expanding. To do this, they’ll compare an older chest X-ray with a new one to see if the areas of scarring have grown. In many cases, you doctor may opt to use a CT scan in addition to X-rays.

If the scar is localized, meaning it’s only in one area, or has remained the same size over time, it’s typically harmless. Scars of this nature are generally caused by a previous infection. If the infection that caused this scar has been dealt with, further treatment isn’t necessary.

If the scar is growing or is more widespread, this may indicate consistent exposure to things that can cause lung scarring like toxins or medications. Certain medical conditions can cause scarring, too. This can lead to a problem known as interstitial lung disease (ILD). ILD refers to a set of diseases that decrease the elasticity of the lungs.

Your doctor may also recommend additional testing, such as a lung biopsy, to gather more information or confirm the diagnosis of a disease. In these cases, your doctor will develop a treatment plan to manage the underlying condition and prevent further scarring.

Learn more: Why early treatment is key for pulmonary fibrosis »

The intensity and type of symptoms resulting from lung scarring will vary from person to person.

In most cases, people who have mild or localized lung scarring won’t experience any symptoms.

If you have more extensive lung scarring, such as the kind found in lung fibrosis, it’s often caused by a poor repair response to injury. Common symptoms include:

• shortness of breath (dyspnea)
• fatigue
• difficulty breathing with exercise
• unexplained weight loss
• fingers or toes that widen and become round at the tip (clubbing)
• aching muscles and joints
• dry cough

Your doctor may recommend one or more of the following to help you manage your symptoms:

• Medication: If the scarring is progressing, your doctor will likely prescribe medication that slows scar formation. Options include pirfenidone (Esbriet) and nintedanib (Ofev).
• Oxygen therapy: This may help make breathing easier, as well as reduce complications from low blood oxygen levels. However, it won’t reduce damage to the lungs.
• Pulmonary rehabilitation: This method uses a variety of lifestyle changes to improve your overall health so lung scarring doesn’t cause as many problems. It includes physical exercise, nutrition counseling, breathing techniques, and counseling and support.

Lung function may be maintained if you can prevent further scarring.

In some cases, you can reduce your risk for further scarring by:

• Avoiding or minimizing contact with harmful chemicals, such as asbestos and silica.
• Stopping smoking. Many chemicals in cigarette smoke promote infections, inflammation, and diseases that can cause scarring.
• Taking the appropriate course of medication if you have a lung infection. Follow your doctor’s advice for both treatment course and follow up.
• Sticking to your disease management plan if the scarring results from radiation for lung cancer treatment or another chronic condition. This may include immunotherapy.

Most people with lung scarring won’t need a transplant. This is partially because many lung scars don’t continue to grow or actively harm the lungs. Symptoms can usually be managed without surgery.

In cases where lung scarring is severe, such as in pulmonary fibrosis, your doctor may recommend a lung transplant. In this procedure, an unhealthy lung is replaced with a healthy lung donated from another person. Lung transplants can be performed on one or both lungs and on nearly all people without health problems up to age 65. Some healthy people over age 65 may be candidates as well.

Lung transplants do carry some short-term risks, including:

• rejection of the new lung, although this risk is reduced by selecting a good match and proper preparation of the immune system
• infection
• blockage of airways and blood vessels from the lungs
• fluid filling the lung (pulmonary edema)
• blood clots and bleeding

Extensive lung scarring is life-threatening and can lead to the following complications:

• blood clots in the lungs
• lung infection
• lung collapse (pneumothorax)
• respiratory failure
• high blood pressure within the lungs
• right-sided heart failure
• death

Although small lung scars are generally benign, there are some cases where scarring may expand or be deep enough to impact your overall health.

See your doctor if you consistently experience any of the following symptoms:

• night sweats or chills
• fatigue
• shortness of breath
• unexpected weight loss
• fever
• ongoing cough
• decreased ability to exercise

Small lung scars aren’t harmful to your overall health and don’t require special treatment. Sometimes, more extensive scarring may indicate an underlying medical condition, such as pulmonary fibrosis, and need to be managed through treatment. In cases where medication doesn’t slow or control the ongoing scarring, a lung transplant may be necessary.

Keep reading: Pulmonary fibrosis vs. COPD: Learn the difference »