Lung Cancer - 67-year-old man with three pulmonary nodules

History
67-year-old man with three pulmonary nodules detected on recent CT scan, referred for PET/CT.

PET/CT Findings
There are three nodules noted on the CT portion of this examination, 2 in the right lung and one in the left. Medial lesion within the right lung demonstrates marked FDG uptake. The remaining nodule in the right lung and the left lung nodule demonstrates no significant FDG uptake.

Impression
One of three pulmonary nodules demonstrates marked FDG uptake. The remaining two demonstrate no significant FDG uptake. The differential for this finding would include a second primary malignancy which is not FDG avid such as bronchoalveolar carcinoma or well differentiated adenocarcinoma or a benign lesion such as hamartoma or granuloma.

Discussion
This is a very interesting case of a gentleman with three pulmonary nodules on an outside CT scan. He was referred for PET/CT, which showed only one of the three nodules was FDG avid. A subsequent biopsy of the FDG avid nodule showed adenocarcinoma. The surgeon and the patient decided to resect all three nodules. The pathology of the three nodules showed adenocarcinoma, a more peripheral area of infarct from tumor embolus and in the other lung a benign hamartoma. In this particular case, PET/CT accurately identified the malignant nodule from the other two benign nodules.

Courtesy of
Dr. Todd Blodgett, University of Pittsburgh