Case report Pulmonary aspergilloma: A rare differential diagnosis to lung cancer after positive FDG PET scan Franziska Spycher a , Gregor J. Kocher b , Mathias Gugger c , Thomas Geiser d , Sebastian R. Ott d, * a Department of Pulmonology, Tiefenau Hospital, Bern, Switzerland b Department of Thoracic Surgery, University Hospital (Inselspital) and University of Bern, Bern, Switzerland c Department of Pathology, University of Bern, Bern, Switzerland d Department of Pulmonary Medicine, University Hospital (Inselspital) and University of Bern, Bern, Switzerland article info Article history: Received 4 October 2013 Accepted 14 February 2014 Keywords: PET Lung cancer Pulmonary nodule Pulmonary aspergilloma abstract Early diagnosis and treatment of lung cancer, one of the leading causes of cancer-related death, is important to improve morbidity and mortality. Therefore any suspect solitary pulmonary nodule should prompt the pursuit for a definitive histological diagnosis. We describe the case of a 55-years-old male ex- smoker, who was admitted to our hospital due to recurrent hemoptysis and dry cough. A CT scan showed an irregular nodule of increasing size (28 mm in diameter) in the left lower lobe (LLL). A whole body PET- CT scan (643 MBq F-18 FDG i.v.) was performed and confirmed an avid FDG uptake of the nodule in the LLL, highly suspicious of lung cancer, without any evidence of lymphogenic or hematogenic metastasis. Bronchoscopy was not diagnostic and due to severe adhesions after prior chest trauma and the central location of the nodule, a lobectomy of the LLL was performed. Surprisingly, histology showed a simple aspergilloma located in a circumscribed bronchiectasis with no evidence of malignancy. This is a report of an informative example of an aspergilloma, which presented with symptoms and radiological features of malignant lung cancer. Ó 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/). 1. Introduction Lung cancer is one of the leading causes of cancer-related death for men and women in industrialized countries. Early diagnosis and treatment is crucial to improve morbidity and mortality. Positron emission tomography (PET) is a quantitative molecular imaging technique that has significantly improved diagnosis, staging and evaluation of treatment options for lung cancer patients. Its sensitivity to detect pulmonary malignancies is about 96% [1]. Nevertheless, a variety of non-malignant, mainly granulomatous, infectious, and inflammatory conditions can also lead to an increased fluorodeoxyglucose (FDG) uptake and may thus mimic lung cancer [2]. Therefore the reported specificity of FDG PET is markedly lower, around 78%, than its sensitivity [1]. Thus, with the growing and more widespread usage of FDG PET scans, an increasing number of less common, non-malignant, but neverthe- less PET positive findings, are getting detected. Here we describe the case of a PET positive, irregular pulmonary nodule turning out to be an aspergilloma. 2. Case report Two years before admission, a 55-years-old male ex-smoker (2 pack years) presented to a peripheral hospital with a history of chronic dry cough and intermittent hemoptysis. A CT scan revealed a solitary nodule (15 mm in diameter) in the left lower lobe (LLL) (Fig. 1 panel A). Subsequent bronchoscopy showed neither any suspect endoluminal lesion nor signs of an active bleeding. The cytological evaluation of the bronchial washing and brushing were both negative for malignant cells, neutrophil granulocytes, macrophages and siderophages. Furthermore no growth of pathogenic agents was seen in microbio- logical cultures. Due to the history of very low tobacco smoke expo- sure and a past history of left-sided thoracotomy for evacuation of intrathoracic hematoma after severe chest trauma 40 years ago, thus having the potential for residual intrapulmonary scar tissue, follow-up imaging was recommended by the treating physicians. The patient was then admitted to our hospital due to another episode of recurrent hemoptysis and dry cough following an acute * Corresponding author. University Hospital of Bern (Inselspital), Dept. of Pulmo- nology, CH-3010 Bern, Switzerland. Tel.: þ41 31 632 34 90; fax: þ41 31 632 98 33. E-mail address: sebastian.ott@insel.ch (S.R. Ott). Contents lists available at ScienceDirect Respiratory Medicine Case Reports journal homepage: www.elsevier.com/locate/rmcr http://dx.doi.org/10.1016/j.rmcr.2014.02.003 2213-0071/Ó 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/). Respiratory Medicine Case Reports 12 (2014) 1e3