An elderly female, lifelong non-smoker, with rheumatoid arthritis treated with methotrexate and prednisone for 10 years was referred for evaluation of incidentally detected, randomly distributed pulmonary nodules on a CT performed for pleuritic chest pain and dyspnoea (figure 1A). Subsequent [18F]fluoro-d-glucose (FDG)-positron emission tomography (PET) showed the nodules had increased in size and were FDG-avid (figure 1B). Patient underwent percutaneous biopsy at an external institution with pathology reported to be highly suspicious for lung adenocarcinoma. Figure 1 (A) CT angiogram performed for evaluation of pleuritic chest pain and dyspnoea demonstrated incidental solid, non-calcified left lower lobe subpleural predominant pulmonary nodules (arrow, additional nodules not shown). Note dependent atelectasis presenting as ground-glass opacities. (B) [18F]fluoro-d-glucose (FDG)-positron emission tomography performed 4 months later showed these nodules had more than doubled in size and were FDG-avid (arrow). No additional FDG avidity was detected elsewhere. After an unrevealing bronchoscopy with bronchoalveolar lavage, the patient was referred to our institution for further care. Re-evaluation of the previous percutaneous …

中文翻译：

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伪装成恶性肿瘤的难治性肉芽肿性 耶氏肺孢子菌肺炎


一名终生不吸烟的老年女性，患有类风湿性关节炎，接受甲氨蝶呤和泼尼松治疗 10 年，被转诊以评估因胸膜炎性胸痛和呼吸困难而进行的 CT 上偶然发现的随机分布肺结节（图 1A）。随后的 [18F] 氟-d-葡萄糖 （FDG）-正电子发射断层扫描 （PET） 显示结节大小增加并且对 FDG 感兴趣（图 1B）。患者在外部机构接受了经皮活检，病理报告高度怀疑肺腺癌。图 1 （A） 为评估胸膜炎性胸痛和呼吸困难而进行的 CT 血管造影显示偶然出现实性、非钙化的左下叶胸膜下为主肺结节（箭头，未显示其他结节）。注意依赖性肺不张表现为毛玻璃影。（B） 4 个月后进行的 [18F] 氟-d-葡萄糖 （FDG）-正电子发射断层扫描显示这些结节的大小增加了一倍多，并且具有 FDG 亲和性（箭头）。在其他地方未检测到额外的 FDG 亲和力。在支气管肺泡灌洗进行未发现的支气管镜检查后，患者被转诊到我们机构接受进一步护理。重新评估既往经皮 ...