Lung nodules with atypical hyperplasia do not necessarily have vacuoles; some nodules will have vacuoles and some nodules will not have vacuoles. When a nodule occurs in the lung, if a translucent shadow appears inside the nodule, it is called a vacuole, and many types of nodules may have vacuoles, including inflammatory nodules, cancerous nodules, and atypical hyperplastic nodules. However, atypical hyperplastic nodules may also not show vacuoles. When a nodule occurs in the lung, the nature of the nodule needs to be initially determined based on the size, shape, and borders of the nodule, and sometimes a puncture biopsy is needed to further define the type of nodule before deciding on the treatment.