65 yo F with PMHx of HTN, HLD, T2DM, OSA, hypothyroidism, cataracts/glaucoma, and depression who presents to ILD clinic for evaluation of pulmonary nodules.

Recent history to note:

5 years ago
New cough in for which she had a CXR showing multiple nodular opacities in the R hemithorax. Subsequent CT chest showed innumerable bilateral pulmonary nodules ranging between 4-8 mm many of which were bronchocentric Noted mediastinal LAD.

PET/CT showed that most of the nodules demonstrated low level FDG avidity though there was an intense FDG uptake of the pleural-based opacity of the medial segment of the RLL. Subsequent surgical lung biopsy showed focal fibrosis and foreign body giant cell reaction, no evidence of malignancy.

Bronchocentric Nodule Left Upper Lobe

 

Bronchocentric Nodules  and Suggestion of Micronodules

 

Solid Nodules

 

 

 

Wedge Shaped Defects Along the Broncho-vascular Bundle

 

Solid Nodules Along the Small Vessels of the Bronchovascular Bundle in the Left Lower Lobe

4 years ago

Surveillance imaging from showed stable scattered solid spiculated and GG nodules measuring up to 6 mm decreased from 6 years ago

 

2 years ago she reported having weight loss to her PCP prompting her to check CT chest.  P

 

CT 1 yearago

showed interval growth of a 1.5 cm spiculated RUL nodule (previously measured 6 x 5 mm in 4 years prior) which was FDG-avid on subsequent PET/CT

concerning for malignancy. She was sent for IR biopsy (1 year ago ) which showed necrotizing granuloma without culture growth and no evidence of malignancy.

 

 

• Radiopedia

•  infectious
  • pulmonary histoplasmosis
  • pulmonary non tuberculous mycobacterial infection
• non-infectious
  • pulmonary sarcoidosis
  • granulomatosis with polyangiitis
  • rheumatoid lung nodules
  • chronic granulomatous disease