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Case report
Flip flop fungus sign: an FDG PET sign of benign pulmonary nodules
  1. Valeri Kraskovsky1,
  2. Brianne MacKenzie2,
  3. Ayesha Arshad3,4 and
  4. Martin Jeffery Mador5,6
  1. 1Pulmonary and Critical Care Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
  2. 2Biomedical Informatics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
  3. 3Pathology and Anatomical Sciences, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
  4. 4Pathology, VA Western New York Healthcare System Buffalo VA Medical Center, Buffalo, New York, USA
  5. 5Pulmonary, Critical Care and Sleep Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
  6. 6Department of Medicine, VA Western New York Healthcare System Buffalo VA Medical Center, Buffalo, New York, USA
  1. Correspondence to Dr Valeri Kraskovsky; valerikr{at}buffalo.edu

Abstract

A 71-year-old man was referred to pulmonary clinic for incidental findings of hypermetabolic lung nodule and mediastinal adenopathy on CT FDG PET performed for evaluation of cough. The patient underwent bronchoscopy with endobronchial ultrasound that was non-diagnostic. The patient was subsequently sent for video-assisted thoracoscopic lymph node biopsy notable for confluent caseating granulomas due to chronic infection by Histoplasma capsulatum. Review of previous PDG PET was notable for the flip flop fungus sign—a PDG PET finding that could have altered the patients’ clinical course by potentially avoiding the need for invasive surgical tissue diagnosis.

  • respiratory medicine
  • TB and other respiratory infections
  • radiology
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Footnotes

  • Contributors VK, BM and MJM contributed to the writing and editing of the manuscript. AA contributed figures and in editing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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