CTICasesAdenocarcinoma Arising within Pulmonary Fibrosis
Imaging findings
A 70-year-old undergoing lung cancer screening has combined pulmonary fibrosis and emphysema with posterior lower lobe subpleural reticulation, and a subtle focal area of ground glass in the superior lungs that was initially overlooked (read as Lung-RADS 2). On follow-up CT two years later the ground glass persisted with a couple of small punctate solid components and mild FDG uptake, and biopsy showed a well-differentiated adenocarcinoma with no metastases.
Key takeaways
A subtle focal area of relatively increased ground glass can be easily overlooked against a background of pulmonary fibrosis or CPFE and may represent an early adenocarcinoma. Such part-solid ground-glass nodules present a Lung-RADS judgment call, and in fibrosis it is prudent to favor a shorter follow-up; biopsy versus direct resection is partly institutional, with the caveat that PET is often falsely positive in fibrosis and endemic fungal disease.
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