Solitary Pulmonary Nodule

65-year-old male with 40-pack-year smoking history. Incidental finding on cardiac CT.

Clinical Presentation

A 65-year-old male with a 40-pack-year smoking history presents for evaluation of an incidental pulmonary nodule found on cardiac CT performed for chest pain.

The nodule measures 12mm in the right upper lobe. It is spiculated with ground-glass attenuation around the periphery.

Follow-up CT at 3 months shows interval growth to 15mm. PET-CT demonstrates moderate FDG avidity (SUV max 4.5).

Given the patient's smoking history and concerning features, a CT-guided biopsy was performed.

Pathology revealed adenocarcinoma of the lung, EGFR mutation positive.

Key Imaging Findings

• 12mm spiculated nodule with ground-glass component
• Interval growth on follow-up
• Moderate FDG avidity on PET-CT
• EGFR mutation positive adenocarcinoma

Discussion

This case highlights the importance of evaluating incidental pulmonary nodules, especially in patients with significant smoking history. The Fleischner Society guidelines recommend follow-up for nodules >8mm with suspicious features. EGFR mutation testing is crucial for guiding targeted therapy.