Fig. 12

Incidental finding of a pulmonary nodule in a 72-year-old man with thoracic pain in whom the initial chest CT was performed to rule out pulmonary embolism. Three lesions were found: a a 15 mm nodule with moderate uptake on 18F–FDG-PET in the right upper lobe, b a 9 mm nodule with no uptake in the right middle lobe and c a triangular nodule in the right lower lobe with no uptake on PET. Both lesions in the right upper and middle lobe showed a suspicious spiculated morphology. The lesion in the right lower lobe was thought to be an intrapulmonary lymph node because of the morphology and location. Although the multidisciplinary thoracic oncology tumour board was convinced that this nodule was probably benign, the board decided to recommend resection (with a small wedge excision) to rule out malignancy with certainty since the other two lesions looked both suspicious. Histopathologic examination after wedge excision of the three nodules showed acinar type adenocarcinoma in the largest lesion, adenocarcinoma with some lepidic growth (which explains why PET was negative in this lesion) in the smallest spiculated lesion and confirmed diagnosis of an intrapulmonary lymph node in the right lower lobe