The case of a 63-year-old woman with a solitary pulmonary nodule (SPN) is reported. Surgical wedge resection revealed an hamartoma. Digital examination of the lung parenchyma showed an unexpected (not previously visualized by thoracic imaging) second nodule that intraoperative frozen examination revealed an adenocarcinoma. The operation was completed with a right upper lobectomy and complete lymphoadenectomy. The authors recommend an early open surgical procedure for any SPNs with risk factors for developing lung cancer.