Vol.23 No.2

Case Report

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

Authors

Takeshi Saraya1 , Ryota Tanaka2 , Masachika Fujiwara3 , Hitoshi Koji4 , Miku Oda1 , Yukari Ogawa1 , Tomoko Nagatomo1 , Masato Watanabe1 , Takuma Yokoyama1 , Haruyuki Ishii1 , Hidefumi Takei2 , Tomoyuki Goya2, Hajime Takizawa1, Hajime Goto1

  • Department of Respiratory Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
  • Department of General Thoracic Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, Japan
  • Department of Pathology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, Japan
  • Department of Nephrology and Rheumatology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, Japan
Received:

27 July 2011

Accepted:

1 May 2012

Published online:

6 June 2012

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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.

Key words

Video-assisted thoracic surgery - Rheumatoid nodule - FDG-PET - Lung cancer - Vasculitis