If a lung nodule was found on a CT scan and was never followed up — and you were later diagnosed with advanced lung cancer — you may have a medical malpractice claim in Pennsylvania. The Fleischner Society Guidelines require specific follow-up timelines based on nodule size and patient risk. When physicians, radiologists, or hospital systems fail to act on those guidelines, the legal standard of care has been breached. The difference between Stage I and late-stage diagnosis can be the difference between a cure and a death sentence.
The CT scan found something. The radiologist noted it in the report. And then … nothing happened.
No one called you. No one ordered a follow-up scan. No one sat down with you and said, “We found a nodule in your lung. Here’s what we need to do next.” Instead, the report was filed, the appointment ended, and life went on. Days passed. Months passed. A year passed.
When the cough started, or the weight loss, or the shortness of breath, when another doctor finally ordered another scan, the nodule was no longer small. It was no longer early-stage. And the cancer that could have been caught, treated, and possibly cured was now something far more serious.
At Lupetin & Unatin, we have represented families across Western Pennsylvania whose loved ones received this exact diagnosis. Not because lung cancer is always curable, but because the window to cure it was open, and their doctors never walked through it. In our experience, lung nodule follow-up failures are among the most heartbreaking and preventable forms of cancer malpractice we see. The system found the problem. The system then forgot about it.
This article is designed to help you understand what should have happened, why it often doesn’t, and what your legal rights are in Pennsylvania if you or someone you love has been harmed by a missed or delayed lung nodule follow-up.
The Stakes: Why Lung Nodule Follow-Up Is a Matter of Life and Death
Lung cancer is the leading cause of cancer deaths in the United States. According to the American Lung Association’s 2024 State of Lung Cancer Report, only 27.4% of lung cancer cases are diagnosed at an early stage — when the five-year survival rate is 64%. An alarming 43% of cases are not caught until a late stage, when the survival rate drops to just 9%.[1]
Early-stage lung cancer: 64% five-year survival rate. Late-stage lung cancer: 9% five-year survival rate. (American Lung Association, State of Lung Cancer 2024[1]) The difference between those two numbers is often a missed follow-up.
Despite these stakes, only 16% of those eligible for lung cancer screening were actually screened in 2022. That gap — between who should be screened and who is — represents thousands of nodules that are detected too late, or not at all.
What Is a Lung Nodule, and Why Does It Matter?
A pulmonary nodule, also called a lung nodule or “coin lesion,” is a small, rounded growth in the lung tissue, typically measuring 3 centimeters or less in diameter. Nodules are extremely common. They are discovered in millions of Americans every year, most often incidentally on CT scans ordered for other reasons: a chest injury, chest pain, a pre-surgical screening, or a cardiovascular workup.
The vast majority of lung nodules are benign, scar tissue from old infections, granulomas, or harmless calcifications. But a meaningful percentage are malignant, or will become malignant. And here is the critical clinical reality that every physician and radiologist is trained to understand: the size and staging of the tumor at diagnosis is the single most important factor in patient survival.
This is why nodule follow-up is not optional. It is not a courtesy. It is a core medical obligation — one with life-or-death consequences when it fails.
The Standard of Care: The Fleischner Society Guidelines
The medical community has developed detailed, evidence-based guidelines for lung nodule management. The most widely used are the Fleischner Society Guidelines, last updated in 2017 and published in Radiology (MacMahon et al., Radiology 2017; 284:228–243). These guidelines are recognized by radiologists and pulmonologists nationwide as the standard of care for incidentally detected pulmonary nodules.
Under the Fleischner Society Guidelines:
- Solid nodules larger than 6mm in a high-risk patient typically require CT follow-up in 6–12 months, and again at 18–24 months.
- Nodules with certain “ground glass” or “subsolid” characteristics may require even more aggressive monitoring, with follow-up extended up to 5 years.
- Nodules that grow on follow-up imaging should trigger immediate further evaluation, including possible biopsy or PET scan.
- The radiologist is expected to include a specific follow-up recommendation in the imaging report itself.
- The ordering physician is expected to communicate this finding to the patient and ensure the follow-up actually occurs.
In our experience handling lung nodule cases in Pennsylvania, the breakdown happens at one of several points: the radiologist recommends follow-up but the ordering doctor never reviews the report carefully; the doctor reviews it but never tells the patient; the patient is told but the follow-up is never scheduled; or the follow-up is scheduled but never flagged as overdue when the patient doesn’t show. Each of these failures is a potential departure from the standard of care.
A Case We Handled: How a Hospital’s “Systems Failure” Cost a Blair County Grandmother Her Life
The following is based on a real matter handled by Lupetin & Unatin, LLC. Names and identifying details have been changed to protect the privacy of the family.
“Patricia” — Blair County, Pennsylvania — Confidential Settlement
Patricia was a 63-year-old grandmother from Hollidaysburg, Pennsylvania. She was a lifelong member of her local volunteer fire company, a devoted wife of more than thirty years, and the center of her family’s life. In May 2013, she went to a hospital emergency room complaining of abdominal pain. She was diagnosed with a kidney stone. As part of her workup, the ER ordered a CT scan of her abdomen and pelvis.
The radiologist did their job correctly. In the report, they clearly noted an “incidental finding”: a 1.4 cm nodule in the lower lobe of her left lung, with an explicit recommendation for follow-up chest CT to evaluate for malignancy.
What happened next was a textbook systems failure. The ER physician treated the kidney stone and discharged her. The follow-up recommendation was buried in the paperwork. No one told Patricia about the nodule. No one sent the report to her primary care physician. For 15 months, she went about her life completely unaware that cancer was growing inside her.
When she returned to the hospital in August 2014 with undeniable symptoms, a new scan revealed the truth. The 1.4 cm nodule had transformed into Stage IV lung cancer. It had metastasized to her brain and other organs. She never left the hospital. She never got to say a calm goodbye to her husband or her grandchildren. She died within weeks.
Our oncology experts testified that back in May 2013, the nodule was likely Stage I or Stage II. Had anyone simply told Patricia about the result, she would have been a candidate for curative surgery or stereotactic body radiation therapy (SBRT). The 15-month delay didn’t just shorten her life — it robbed her of the quality of her final chapter.
At Lupetin & Unatin, we litigated this case aggressively in the Court of Common Pleas of Blair County. We retained the necessary medical experts who opined about both the systems failure and the lost chance of survival. We secured a substantial confidential settlement for Patricia’s estate. No amount of money could return her to her family. But the settlement forced accountability and sent a message that hospitals must have fail-safe protocols for communicating incidental findings to patients.
Where the System Fails: Common Lung Nodule Malpractice Scenarios
1. The Radiologist’s Report Is Buried in the Chart
Radiologists do not typically call patients directly. They issue reports that go into the electronic medical record and are meant to be reviewed by the ordering physician. When the ordering physician, whether a primary care doctor, ER physician, or specialist, fails to review that report or fails to act on the follow-up recommendation within it, patients fall through the cracks.
At Lupetin & Unatin, we have seen cases where a radiologist’s report clearly stated “Recommend follow-up CT in 6 months” and the ordering physician signed off on the report without scheduling any follow-up or notifying the patient. Years later, when the nodule had become a mass, no one in the system could explain why the recommendation had been ignored.
2. The Radiologist Fails to Report the Nodule
Radiologists review complex images under significant time pressure, often reading dozens or hundreds of scans per day. In some cases, a nodule that should have been reported is simply missed. In our experience, when a nodule is visible on a prior imaging study and was not mentioned in the radiology report, that prior study becomes powerful evidence in a malpractice case. Radiologists are trained to identify and report these findings. Failure to do so, when the nodule was visible and a reasonable radiologist would have seen it, is negligence.
3. The Incidental Finding Goes Uncommunicated to the Patient
Sometimes the nodule is found and reported, but no one tells the patient. This happens with shocking frequency in emergency settings, particularly with incidental findings on scans ordered for something else entirely. Patricia’s case is a perfect example. A patient comes in for abdominal pain, has a CT, and the lower lung fields show a nodule. The abdominal findings are normal, the ER physician focuses on the reason for the visit, and the lung finding is never communicated.
Pennsylvania law is clear: physicians have a duty to communicate material test results to their patients. A lung nodule is always a material finding. The failure to inform a patient of a pulmonary nodule, and to explain the follow-up required, is a breach of that duty.
4. The Follow-Up Is Ordered But Never Completed
Even when the patient is told about a nodule and a follow-up scan is ordered, the follow-up sometimes never happens. Healthcare systems have an obligation to track and follow up on critical pending orders, particularly for cancer surveillance. When the system fails to do so, and when the provider never makes any effort to ensure the test was completed, that failure can be the basis of a malpractice claim.
5. Growth Is Documented and Ignored
Perhaps the most egregious scenario we encounter is when a nodule is identified, followed up on schedule, documented as having grown, and then nothing is done. A nodule that increases in size is a serious warning sign. The Fleischner Society Guidelines require escalation: additional imaging, referral to pulmonology or thoracic surgery, bronchoscopy, or biopsy. When a physician sees documented growth and continues to “watch and wait” without any additional workup, that passivity can be fatal.
Lung Cancer Screening Programs — and Their Failures
Since 2021, the U.S. Preventive Services Task Force (USPSTF) has recommended annual low-dose CT (LDCT) lung cancer screening for adults aged 50–80 who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. These screening programs are designed specifically to catch lung cancer early, before symptoms develop, when treatment is most effective.
Despite this recommendation, as of 2022, only 16% of those eligible were actually screened.[1] Screening programs are only as good as the follow-up systems behind them. At Lupetin & Unatin, we have handled cases where patients enrolled in hospital-sponsored lung cancer screening programs, received positive screening results, and then received no follow-up, because the program had no adequate tracking mechanism to ensure patients were contacted when their results required action.
The existence of a formal screening program creates a heightened duty of care. When a healthcare system markets a lung cancer screening program and then fails to follow up on positive results, that is not just a communication breakdown. It is a systematic failure that can form the basis of a malpractice claim against the institution.
How We Prove a Lung Nodule Malpractice Case in Pennsylvania
Building the Imaging Timeline
The first thing we do in any lung nodule case is build a complete medical imaging timeline. We obtain every CT scan, chest X-ray, and PET scan the patient has ever had, often going back 10 or more years. We then work with retained radiology experts to identify the earliest point at which the nodule was visible, and what the Fleischner Society Guidelines required at each step.
In our experience, the most important document in these cases is often the radiology report and imaging from two or three years before the diagnosis, the one that mentioned the nodule quietly in the last line, recommended follow-up, and was never acted upon. We have found cases where a nodule was visible, and missed by the radiologist, on a scan conducted three or four years before the cancer diagnosis. That kind of evidence changes the entire trajectory of a case.
Identifying All Responsible Parties
Lung nodule cases frequently involve multiple defendants: the radiologist who missed or underreported the finding, the primary care physician who failed to act on the report, the specialist who failed to escalate, and sometimes the hospital or health system whose policies and staffing decisions contributed to the failure.
Under Thompson v. Nason, the leading Pennsylvania case on corporate negligence, a hospital can be held directly liable for systemic failures in its credentialing, oversight, and patient safety policies. Patricia’s case was built in part on exactly that theory, that the hospital’s lack of an incidental finding communication protocol was an institutional failure, not merely an individual physician’s oversight.
Proving Causation: Pennsylvania's Increased Risk of Harm Doctrine
Defendants in lung nodule cases almost always make the same argument: even if we had followed up sooner, the cancer might have spread anyway. The outcome, they claim, was inevitable.
Pennsylvania law has a direct answer to that argument.
Under Hamil v. Bashline, the Pennsylvania Supreme Court established that a plaintiff does not need to prove with absolute certainty that earlier diagnosis would have produced a cure. Instead, once a plaintiff introduces evidence that a defendant's negligent act or omission increased the risk of harm to the patient, and that the harm was in fact sustained, causation becomes a question for the jury: whether that increased risk was a substantial factor in producing the harm.
The three elements are straightforward:
- The defendant breached the standard of care;
- That breach increased the patient's risk of the specific harm that occurred, here, advanced-stage lung cancer, metastasis, or death;
- That harm did in fact occur.
This doctrine was built for delayed diagnosis cases. As the court recognized in Hamil, when a defendant's negligence effectively terminates a person's chance at better treatment or survival, the defendant cannot then hide behind uncertainty about what might have happened. The negligence created the uncertainty. The defendant does not get to profit from it.
In lung nodule cases, our experts apply this framework directly to the staging evidence. A nodule identified on imaging at 1.4 cm, if followed up within the Fleischner Society's recommended window, would have been biopsied, staged, and treated while the cancer was still localized. The failure to follow up allowed the cancer to progress, from a surgically resectable early-stage tumor to a late-stage disease with metastatic spread. That progression is the increased risk of harm. The Stage IV diagnosis, the metastasis, the death, that is the harm that resulted.
The statistical backdrop makes the expert's job achievable: the American Lung Association documents a 64% five-year survival rate for early-stage lung cancer versus 9% for late-stage diagnosis. Our oncology experts do not need to prove that this particular patient would have been cured. They need to show that the negligent delay substantially increased the risk of the catastrophic outcome that followed — and that the catastrophic outcome did follow.
Defendants will try to attribute the outcome entirely to the cancer itself, arguing the patient's underlying disease, not the missed follow-up, caused the death. Hamil forecloses that move. A defendant is not insulated from liability merely because a preexisting condition contributed to the harm, as long as the negligence was a substantial factor in bringing about that harm. The nodule existed before the negligence. The Stage IV metastatic disease that killed the patient existed because of it.
Frequently Asked Questions: Lung Nodule Malpractice in Pennsylvania
How do I know if my lung nodule case is malpractice?
If a lung nodule was identified on imaging or should have been identified and no follow-up was recommended, communicated, or completed, and you were later diagnosed with lung cancer at a more advanced stage, you may have a malpractice claim. The key questions are: Was the nodule visible on prior imaging? Did the radiologist report it? Did the physician communicate it to you? Was appropriate follow-up ordered and completed? Contact us for a free case evaluation.
What if I never knew about the lung nodule until my cancer diagnosis?
This is one of the most common scenarios we handle at Lupetin & Unatin. Many patients don’t learn that a prior scan showed a nodule until they review their records after a cancer diagnosis, often years later. The fact that you were never told is itself potential evidence of negligence. Pennsylvania’s statute of limitations for medical malpractice is generally two years from the date you knew or should have known of the malpractice, so it is important to contact an attorney as soon as possible.
Can I sue the hospital as well as the doctor?
Possibly. Under Thompson v. Nason, a hospital can be held directly liable for systemic failures in its policies and patient safety protocols. Patricia’s Blair County case is a prime example: the hospital’s failure to have any protocol for communicating incidental findings was the central negligence, not just one physician’s oversight.
What if the lung cancer has already led to death?
We represent many families who lost a loved one to lung cancer after a missed nodule. Pennsylvania law allows families to bring both a wrongful death claim and a survival action on behalf of the estate. These claims cover the patient’s pain and suffering, lost earning capacity, medical expenses, and the family’s losses, including companionship and the loss of the patient’s final months of quality life.
How long do I have to file a lung nodule malpractice claim in Pennsylvania?
Generally, two years from the date you discovered or should have discovered the malpractice. There is also a statute of repose: in most cases, no claim can be brought more than seven years from the date of the negligent act. Given the complexity of identifying the relevant dates in nodule cases — where the original failure may have occurred years before the diagnosis — it is critical to consult an attorney immediately.
If You Think a Lung Nodule Was Missed or Ignored, Contact Us Now
We regularly see the consequences of a scan result that was never followed up, a recommendation that was never communicated, and a cancer that was found too late. These cases are not the result of bad luck. They are the result of failures that violate the standard of care that every patient in Pennsylvania is entitled to expect.
If you or a family member received a lung cancer diagnosis and you have reason to believe that an earlier scan may have identified a nodule that was never properly followed up, please contact Lupetin & Unatin for a free, confidential case evaluation. We will obtain the records, have them reviewed by qualified experts, and give you an honest assessment of whether you have a case worth pursuing.
The window to catch lung cancer early is narrow. The window to file a malpractice claim is also limited. Do not wait.
