Causes of Pulmonary Nodules Mnemonic

Pulmonary nodules — the “small round thing” that shows up on CT and sends half the ward into a frenzy.
Is it TB? Cancer? A rogue fungus? Or just a random granuloma left behind by a past infection that didn’t get the memo?

In the middle of this diagnostic chaos, we need a calm, structured approach. That’s where our favorite exam-oriented mnemonic comes in handy: “GAMES”.

Because let’s be honest — figuring out a solitary pulmonary nodule sometimes feels like playing a game of Minesweeper. 💣

🧠 Mnemonic: “GAMES” — Causes of Pulmonary Nodules

Letter	Cause	Key Notes
G	Granuloma (TB, fungal)	By far the most common cause in Balochistan. Think TB until proven otherwise. Especially when the patient is from Awaran or Zhob and has weight loss + cough + a story that starts with “6 months ago…” 😷
A	AV Malformation	Rare but dramatic. Hemoptysis + clubbing. Pulmonary angiogram is the MVP here. Dr. Imran Baloch once picked this on echo — legend. 🔍
M	Metastasis	Multiple nodules? Think renal, breast, colon, or choriocarcinoma. Don’t let age fool you — I’ve seen a 35-year-old from Dalbandin present with cannonball mets. 🎱
E	Epithelial Tumor (e.g., carcinoid)	Classic for central nodules. Slow-growing, may present with hemoptysis or a bronchial obstruction. Bonus if the CT shows popcorn calcification. 🍿
S	Sequestration	A congenital beast. Non-functioning lung segment with systemic arterial supply. Not your usual suspect, but Dr. Danish Ramzan loves these. Always CT angio to confirm. 🧬

📍 Clinical Experience from Quetta

Last month, I had a middle-aged schoolteacher from Washuk who came in with persistent dry cough and fatigue. Chest X-ray showed a solitary RUL nodule.
Dr. Basit Khan suspected TB (as always) and started workup — but the sputum was negative. CT showed a well-defined lesion with central necrosis. Biopsy? Fungal granuloma — Histoplasma, of all things. 😳