Fluorodeoxyglucose (FDG) uptake in pulmonary rheumatoid nodules diagnosed by video-assisted thoracic surgery lung biopsy: two case reports and a review of the literature

Mod Rheumatol. 2013 Mar;23(2):393-6. doi: 10.1007/s10165-012-0664-3. Epub 2012 Jun 6.

Abstract

Two cases of rheumatoid nodules evaluated by fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and video-assisted thoracic surgery (VATS) biopsy are reported. The first case was that of a 44-year-old woman who presented with a cavitated nodule with intense standardized uptake values (SUVs) both in the early (max 3.4) and delayed (max 4.4) phases, suggesting malignancy. However, after VATS biopsy, she was diagnosed as having a rheumatoid nodule with vasculitis. The second case was that of a 74-year-old woman admitted with bilateral lung nodules, two of which showed intense early (max 2.2) and delayed (max 6.0) phase SUVs, and mild early (max 0.6) and delayed (max 0.9) phase SUVs. These two nodules were finally proven to be a lung cancer and rheumatoid nodule without vasculitis, respectively. These cases show that rheumatoid nodules with an enhanced inflammatory process, such as vasculitis, can appear false-positive for malignancy on FDG-PET/CT scan images.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Large Cell / diagnostic imaging*
  • Carcinoma, Large Cell / pathology
  • Carcinoma, Large Cell / surgery
  • Diagnosis, Differential
  • Female
  • Humans
  • Lung / diagnostic imaging*
  • Lung / pathology
  • Lung / surgery
  • Lung Neoplasms / diagnostic imaging*
  • Lung Neoplasms / pathology
  • Lung Neoplasms / surgery
  • Radionuclide Imaging
  • Rheumatoid Nodule / diagnostic imaging*
  • Rheumatoid Nodule / pathology
  • Rheumatoid Nodule / surgery
  • Thoracic Surgery, Video-Assisted