Prague Med. Rep. 2024, 125, 79-86

An Unusual Etiology of Fluorodeoxyglucose Avid Intrathoracic Lymph Nodes

Alyssa Bonnier1, Santu Saha2, Adam Austin3, Biplab K. Saha3

1Department of Critical Care Nursing, Goldfarb School of Nursing, Barnes Jewish College, Saint Louis, USA
2Department of Medicine, Saha Clinic, Bangladesh
3Department of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, USA

Received November 24, 2022
Accepted January 30, 2024

A middle-aged man in his 50s, active smoker, presented to the pulmonary office for lung cancer evaluation. On a low-dose computed tomography for lung cancer screening, he was found to have an 8 mm endobronchial lesion in the right main stem bronchus. A PET-CT revealed no endobronchial lesion, but incidentally, fluorodeoxyglucose (FDG) avidity was present in the right hilar (SUV 13.2) and paratracheal lymph nodes (LNs). He underwent bronchoscopy and EBUS-TBNA of station 7 and 10 R LNs. The fine needle aspiration (FNA) revealed necrotizing epithelioid granuloma. The acid-fast bacilli (AFB) and Grocott methenamine silver (GMS) stains were negative. He had suffered from pneumonic tularemia 13 months ago and immunohistochemical staining for Francisella tularensis on FNA samples at Center for Disease Control and Prevention was negative. The intense positron emission tomography (PET) avidity was attributed to prior tularemic intrathoracic lymphadenitis without active tularemia, a rare occurrence. To the best of our knowledge, PET-positive intrathoracic lymph node beyond one year without evidence of active tularemia has not been previously reported.


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