When A Missed Pulmonary Nodule on a CT Scan Becomes Medical Malpractice

A pulmonary nodule shows up on a CT scan more often than most people realize. It is a small spot in the lung, usually round and usually under an inch across, and most of the time it turns out to be nothing serious: old scar tissue, a healed infection, or a benign growth.

But some nodules are early lung cancer, caught at exactly the stage when treatment works best. When a nodule like that is missed, misread, or never followed up, the cancer keeps growing quietly until it is no longer early.

That question has a real legal answer. Not every missed nodule is malpractice. But a specific, well-documented set of circumstances can turn a missed finding into a valid claim, and understanding the difference is the first step toward figuring out what happened.

What a Pulmonary Nodule Is and Why Follow-Up Matters

The American Cancer Society defines a lung nodule as an abnormal area 3 centimeters or smaller. Anything larger is called a mass and treated with more immediate suspicion. Most nodules are found incidentally, on a CT scan done for something else: a car accident workup, a heart test, a pneumonia check, or pre-surgical clearance.

For these incidental nodules, radiologists in the United States follow the Fleischner Society's 2017 guidelines, written by an international panel of thoracic radiologists, pulmonologists, surgeons, and pathologists. The recommendations depend on the nodule's size, whether it is solid or has a hazier ground-glass appearance, whether there is one nodule or several, and how much risk the patient carries from factors like smoking history, age, and family history.

For a single solid nodule, the guidelines are fairly specific. Nodules under 6 millimeters generally need no routine follow-up in low-risk patients. A nodule of 6 to 8 millimeters calls for a follow-up CT in 6 to 12 months, and high-risk patients get a second scan at 18 to 24 months. For a solid nodule larger than 8 millimeters, the guidelines call for considering a CT in about 3 months, a PET/CT scan, a biopsy, or some combination. Ground-glass and part-solid nodules have their own schedules, often with follow-up lasting five years. The guidelines also tell radiologists to compare the current scan against any earlier imaging to look for growth.

Nodules found on a yearly lung cancer screening scan are handled under a different system, the American College of Radiology's Lung-RADS categories. The ACS screening guideline recommends yearly low-dose CT for people ages 50 to 80 who smoke or used to smoke and have at least a 20 pack-year history.

That follow-up window is the heart of most missed-nodule cases. A nodule flagged for a scan in 6 months, with no one ever scheduling that scan, is not an unfortunate gap. It is a break in a system designed to catch exactly this kind of finding. Our page on how lung cancer is diagnosed walks through the tests that follow a suspicious finding.

How a Nodule Gets Missed

Missed nodules rarely come down to one dramatic mistake. They tend to happen at a handful of recurring failure points, and which one applies matters because it changes who may be responsible.

The first is a perceptual error: the radiologist looks at the scan and does not see the nodule. It is a well-recognized kind of radiology miss, and it is more likely with small nodules or ones tucked behind a rib, near the heart, or close to the spine.

The second is an interpretive error. The radiologist sees the nodule but reads it as a scar, an old infection, or an imaging artifact, and does not recommend follow-up. A radiologist who never pulls up a prior scan for comparison can also miss slow growth that would have been obvious side by side.

The third, and often the most damaging in court, is a communication breakdown. The radiologist sees the nodule and writes a follow-up recommendation into the report, but it never reaches anyone who acts on it. The ordering doctor reads only the summary line. The recommendation is buried in a long report about something else, such as an emergency room scan for chest pain. Or the practice has no system to turn "repeat CT in 6 months" into an appointment.

That tracking failure is increasingly where these claims center. A hospital or imaging center that routinely generates follow-up recommendations but has no reliable way to confirm patients come back has a structural problem, not a one-time slip.

When a Missed Nodule Becomes Malpractice

Not every missed or misread nodule is malpractice. Medicine involves judgment, and careful radiologists sometimes miss things that look obvious only in hindsight. The legal standard is not perfection. It is whether the care fell below what a reasonably careful provider in the same specialty would have done under the same circumstances.

These cases usually turn on a few questions. Did the nodule meet the size or risk criteria that called for follow-up under accepted guidelines, and was follow-up never recommended? Was follow-up recommended in the report but never passed on to the ordering doctor or the patient? Was the patient told to come back, with no system to make sure it happened? And did the delay matter, meaning did the cancer progress to a more advanced stage while it went unaddressed?

That last question often decides whether a case is worth pursuing. If a nodule was missed for eight months but turned out to be benign, there is no injury and no case. If a nodule was missed for two years and a stage 1 lung cancer, often curable with surgery alone, became stage 3 or 4 disease requiring chemotherapy and radiation, that change in prognosis is the core of the claim.

Can You Sue for a Missed Pulmonary Nodule in New York?

You may be able to. New York law allows a malpractice claim when a radiologist, primary care physician, pulmonologist, emergency physician, or the hospital or imaging center itself departs from accepted medical practice and that departure is a substantial factor in causing real harm.

Proving a missed-nodule claim generally requires three things. First, a departure from the standard of care: the nodule was not flagged, not communicated, or not tracked the way accepted guidelines required. Second, causation: the departure led to a worse outcome, not just an unfortunate coincidence. Third, damages, such as a lower chance of survival, harsher treatment than would otherwise have been needed, added medical bills, lost income, or in the most serious cases, death.

New York requires expert testimony on the first two points in virtually every case like this. A radiologist or oncologist has to be able to say, based on the actual images and records, that the nodule met criteria for follow-up and that earlier detection would likely have meant a meaningfully better outcome. Cases built on hindsight alone do not get far, which is why an early record review matters so much.

New York also requires a certificate of merit under CPLR 3012-a. Before filing, the attorney must certify that they consulted at least one physician and concluded there is a reasonable basis for the claim. It is one more reason the medical review has to happen before a case is filed, not after.

How Long Do You Have to File?

Under CPLR 214-a, the general deadline for a New York malpractice lawsuit is two years and six months from the act or omission. Missed cancer cases often benefit from a 2018 amendment commonly called Lavern's Law.

The law is named for Lavern Wilkinson, a Brooklyn mother whose lung cancer was missed until it was too late to treat. Her case is close to the fact pattern this article describes. For a claim based on a negligent failure to diagnose cancer, the two-and-a-half-year period runs from the later of two dates: when you knew or reasonably should have known of the negligent act and the harm it caused, or the date of your last continuous treatment. The discovery rule has an outer limit of seven years from the negligent act.

This matters a great deal in missed-nodule cases, which are often discovered only years later. A patient may have no idea anything was missed until a new scan, done for an unrelated reason, shows a cancer that was plainly visible on an old image.

The continuous treatment rule can also delay the start of the clock when a patient kept seeing the same doctor or practice for ongoing care of the same condition. If the scan was read or the follow-up was dropped at a public hospital, such as one run by NYC Health + Hospitals or a county, a formal notice of claim generally must be served within 90 days under General Municipal Law § 50-e. Because these rules are fact-specific and a missed deadline is permanent, an early conversation with an attorney can clarify exactly where a case stands.

Why the Stage at Diagnosis Matters So Much

Lung cancer is by far the leading cause of cancer death in the United States. According to the American Cancer Society, more people die of it each year than of colon, breast, and prostate cancers combined.

Stage at diagnosis drives survival. For non-small cell lung cancer, the most common type, ACS survival data shows a five-year relative survival rate of 67 percent when the cancer is still confined to the lung. That falls to 40 percent once it reaches nearby lymph nodes or structures and to 12 percent when it has spread to distant organs.

That gap is why months or years between when a nodule should have been flagged and when the cancer was finally diagnosed can be real, measurable harm. It is the difference between a treatment plan that might have been surgery alone, with a strong chance of cure, and one that now involves chemotherapy, radiation, and a far more guarded prognosis. Expert testimony on how fast the nodule grew between scans is often what connects the delay to the outcome.

Talk With a New York Cancer Lawyer

If an old scan showed a nodule that no one followed up, the timeline in your records may tell the whole story. You can read about lung cancer malpractice claims and our clients' stories. Porter Law Group's New York cancer lawyers work with board-certified radiology and oncology experts, and you can see our results in delayed cancer diagnosis cases. Call 833-888-LATE or request a free case evaluation.

Attorney advertising. This article provides general information and is not legal or medical advice. Prior results do not guarantee a similar outcome. Filing deadlines depend on the facts of each case.

Frequently Asked Questions

Can I sue if a radiologist missed a lung nodule on my CT scan?

You may be able to. A claim generally requires showing that the nodule met accepted criteria for follow-up, that it was missed, misread, or never acted on, and that the delay let the cancer advance to a harder-to-treat stage. A radiologist or oncologist must review the images and records to support the claim.

What follow-up is required for a lung nodule found on CT?

It depends on size, type, and risk. Under the Fleischner Society's 2017 guidelines, a solid nodule under 6 millimeters in a low-risk patient usually needs no routine follow-up. A 6 to 8 millimeter nodule calls for a repeat CT in 6 to 12 months. A solid nodule over 8 millimeters may call for a 3-month CT, a PET/CT scan, or a biopsy.

Who is responsible when a lung nodule follow-up never happens?

It depends on where the chain broke. A radiologist may be responsible for missing or misreading the nodule. An ordering physician may be responsible for not acting on a follow-up recommendation in the report. A hospital or imaging center may share responsibility if it had no system to track recommended follow-up scans.

Is a missed lung nodule always malpractice?

No. Some nodules are genuinely hard to see, and most turn out to be benign. A missed nodule supports a claim only when the care fell below what a reasonably careful provider would have done and the delay caused real harm, such as cancer progressing from an early, operable stage to advanced disease.

How long do I have to file a missed lung nodule claim in New York?

Under Lavern's Law, part of CPLR 214-a, you generally have two years and six months from when you knew or should have known of the mistake and the harm it caused, or from your last continuous treatment. The outer limit is seven years from the missed scan. Public hospitals require a notice of claim within 90 days.