CTICasesResolving Infectious Nodule Mimicking Lung Cancer
Imaging findings
A patient with severe emphysema presented with a newly developed, irregular, spiculated nodule in the right upper lobe on a lung cancer screen. Initial PET imaging showed high avidity. However, by the time a biopsy was scheduled a couple of months later, follow-up imaging demonstrated almost complete resolution of the nodule without any intervening treatment.
Key takeaways
Highly suspicious, spiculated pulmonary nodules, even those that are FDG-avid on PET, can represent inflammatory or infectious processes rather than malignancy, especially in the setting of underlying emphysema. This case emphasizes the value of a "tincture of time" and short-term follow-up imaging to assess for resolution, avoiding unnecessary aggressive interventions for benign conditions. PET imaging's lack of specificity for distinguishing infection from malignancy is highlighted.
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