Learning Resources
Clinical Cases
Oncology Cases
Case 1: Solitary Pulmonary Nodule

Case 1: Solitary Pulmonary Nodule

Clinical History

Patient: 58-year-old female History: Incidental 1.5 cm right upper lobe nodule found on screening CT Indication: Characterization of Solitary Pulmonary Nodule (SPN)

Imaging Findings

Technique: F-18 FDG PET/CT (Vertex to mid-thighs)

PET/CT Fusion

  • Located in the right upper lobe, there is a hypermetabolic nodule measuring 1.6 x 1.5 cm.
  • SUV max: 12.4
  • No hilar or mediastinal lymphadenopathy.
  • No distant metastasis.

PET/CT scan of solitary pulmonary nodule

Diagnosis

Findings:

  • Intensely hypermetabolic pulmonary nodule (SUV > 2.5 is typically suspicious).
  • Absence of benign calcification patterns.

Interpretation: High probability of malignancy. Biopsy is recommended.

Pathology Follow-up: Adenocarcinoma.

Learning Points

  1. SUV Thresholds: While SUV > 2.5 suggests malignancy, overlap exists with granulomatous disease (e.g., Histoplasmosis, TB).
  2. SPN Evaluation: PET/CT has high sensitivity (~95%) for nodules > 1 cm.
  3. False Negatives: Can occur with carcinoid tumors and mucinous adenocarcinomas (low metabolic activity).
  4. False Positives: Infection, inflammation, granulomas.