Kaolin pneumoconiosis may produce radiologic findings similar to those of malignancy. Current management includes serial radiologic examination and lung sampling of suspicious parenchymal opacities and nodules to exclude associated malignancy. This may result in unnecessary pulmonary resections in patients with already compromised lung function. In a patient with known kaolin pneumoconiosis and multiple nodules, we used positron emission tomography to identify suspicious areas for malignancy that were confirmed by open lung biopsy, leading to successful lung cancer treatment.