CTICasesIntrapulmonary Lymph Node Mimicking a Solitary Pulmonary Nodule
Imaging findings
In a patient with interstitial lung disease, a nodule adjacent to a fissure appeared round to mildly lobulated on axial images but more triangular on coronal reformats, an appearance suggestive of a perifissural or intrapulmonary lymph node despite being somewhat larger than typical. Given the patient's risk factors, biopsy was performed and confirmed a benign intrapulmonary lymph node; the nodule remained stable in size on follow-up imaging roughly a year later.
Key takeaways
Perifissural, triangular-shaped nodules in patients with interstitial lung disease should suggest an intrapulmonary (perifissural) lymph node rather than malignancy, a diagnosis supported by published series showing essentially none of these nodules prove malignant on long-term follow-up. Recognizing this morphology, even when the nodule is larger than typical, can spare patients unnecessary biopsy in most cases.
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