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Borgheresi A, Agostini A, Pierpaoli L, Bruno A, Valeri T, Danti G, Bicci E, Gabelloni M, De Muzio F, Brunese MC, Bruno F, Palumbo P, Fusco R, Granata V, Gandolfo N, Miele V, Barile A, Giovagnoni A. Tips and Tricks in Thoracic Radiology for Beginners: A Findings-Based Approach. Tomography 2023; 9:1153-1186. [PMID: 37368547 DOI: 10.3390/tomography9030095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/03/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
This review has the purpose of illustrating schematically and comprehensively the key concepts for the beginner who approaches chest radiology for the first time. The approach to thoracic imaging may be challenging for the beginner due to the wide spectrum of diseases, their overlap, and the complexity of radiological findings. The first step consists of the proper assessment of the basic imaging findings. This review is divided into three main districts (mediastinum, pleura, focal and diffuse diseases of the lung parenchyma): the main findings will be discussed in a clinical scenario. Radiological tips and tricks, and relative clinical background, will be provided to orient the beginner toward the differential diagnoses of the main thoracic diseases.
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Affiliation(s)
- Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Luca Pierpaoli
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Alessandra Bruno
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Tommaso Valeri
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Ginevra Danti
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Eleonora Bicci
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Michela Gabelloni
- Nuclear Medicine Unit, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
| | - Maria Chiara Brunese
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health, Unit 1, 67100 L'Aquila, Italy
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health, Unit 1, 67100 L'Aquila, Italy
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, 16149 Genoa, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
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Diagnostic Imaging and Newer Modalities for Thoracic Diseases: PET/Computed Tomographic Imaging and Endobronchial Ultrasound for Staging and Its Implication for Lung Cancer. PET Clin 2017; 13:113-126. [PMID: 29157382 DOI: 10.1016/j.cpet.2017.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Modalities to detect and characterize lung cancer are generally divided into those that are invasive [endobronchial ultrasound (EBUS), esophageal ultrasound (EUS), and electromagnetic navigational bronchoscopy (ENMB)] versus noninvasive [chest radiography (CXR), computed tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI)]. This chapter describes these modalities, the literature supporting their use, and delineates what tests to use to best evaluate the patient with lung cancer.
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Diagnostic Imaging and Newer Modalities for Thoracic Diseases: PET/Computed Tomographic Imaging and Endobronchial Ultrasound for Staging and Its Implication for Lung Cancer. Surg Clin North Am 2017; 97:733-750. [PMID: 28728712 DOI: 10.1016/j.suc.2017.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Modalities to detect and characterize lung cancer are generally divided into those that are invasive [endobronchial ultrasound (EBUS), esophageal ultrasound (EUS), and electromagnetic navigational bronchoscopy (ENMB)] versus noninvasive [chest radiography (CXR), computed tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI)]. This chapter describes these modalities, the literature supporting their use, and delineates what tests to use to best evaluate the patient with lung cancer.
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Peerlings J, Troost EGC, Nelemans PJ, Cobben DCP, de Boer JCJ, Hoffmann AL, Beets-Tan RGH. The Diagnostic Value of MR Imaging in Determining the Lymph Node Status of Patients with Non-Small Cell Lung Cancer: A Meta-Analysis. Radiology 2016; 281:86-98. [PMID: 27110732 DOI: 10.1148/radiol.2016151631] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose To summarize existing evidence of thoracic magnetic resonance (MR) imaging in determining the nodal status of non-small cell lung cancer (NSCLC) with the aim of elucidating its diagnostic value on a per-patient basis (eg, in treatment decision making) and a per-node basis (eg, in target volume delineation for radiation therapy), with results of cytologic and/or histologic examination as the reference standard. Materials and Methods A systematic literature search for original diagnostic studies was performed in PubMed, Web of Science, Embase, and MEDLINE. The methodologic quality of each study was evaluated by using the Quality Assessment of Diagnostic Accuracy Studies 2, or QUADAS-2, tool. Hierarchic summary receiver operating characteristic curves were generated to estimate the diagnostic performance of MR imaging. Subgroup analyses, expressed as relative diagnostic odds ratios (DORs) (rDORs), were performed to evaluate whether publication year, methodologic quality, and/or method of evaluation (qualitative [ie, lesion size and/or morphology] vs quantitative [eg, apparent diffusion coefficients in diffusion-weighted images]) affected diagnostic performance. Results Twelve of 2551 initially identified studies were included in this meta-analysis (1122 patients; 4302 lymph nodes). On a per-patient basis, the pooled estimates of MR imaging for sensitivity, specificity, and DOR were 0.87 (95% confidence interval [CI]: 0.78, 0.92), 0.88 (95% CI: 0.77, 0.94), and 48.1 (95% CI: 23.4, 98.9), respectively. On a per-node basis, the respective measures were 0.88 (95% CI: 0.78, 0.94), 0.95 (95% CI: 0.87, 0.98), and 129.5 (95% CI: 49.3, 340.0). Subgroup analyses suggested greater diagnostic performance of quantitative evaluation on both a per-patient and per-node basis (rDOR = 2.76 [95% CI: 0.83, 9.10], P = .09 and rDOR = 7.25 [95% CI: 1.75, 30.09], P = .01, respectively). Conclusion This meta-analysis demonstrated high diagnostic performance of MR imaging in staging hilar and mediastinal lymph nodes in NSCLC on both a per-patient and per-node basis. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Jurgen Peerlings
- From the Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology (J.P., E.G.C.T., A.L.H.), Department of Radiology (J.P., R.G.H.B.), and Department of Epidemiology (P.J.N.), Maastricht University Medical Centre, Dr. Tanslaan 12, 6229 ET Maastricht, the Netherlands; Department of Radiation Oncology, University Medical Centre, Utrecht, the Netherlands (D.C.P.C., J.C.J.d.B.); and Department of Radiation Oncology, Dr Bernard Verbeeten Institute, Tilburg, the Netherlands (D.C.P.C.)
| | - Esther G C Troost
- From the Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology (J.P., E.G.C.T., A.L.H.), Department of Radiology (J.P., R.G.H.B.), and Department of Epidemiology (P.J.N.), Maastricht University Medical Centre, Dr. Tanslaan 12, 6229 ET Maastricht, the Netherlands; Department of Radiation Oncology, University Medical Centre, Utrecht, the Netherlands (D.C.P.C., J.C.J.d.B.); and Department of Radiation Oncology, Dr Bernard Verbeeten Institute, Tilburg, the Netherlands (D.C.P.C.)
| | - Patricia J Nelemans
- From the Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology (J.P., E.G.C.T., A.L.H.), Department of Radiology (J.P., R.G.H.B.), and Department of Epidemiology (P.J.N.), Maastricht University Medical Centre, Dr. Tanslaan 12, 6229 ET Maastricht, the Netherlands; Department of Radiation Oncology, University Medical Centre, Utrecht, the Netherlands (D.C.P.C., J.C.J.d.B.); and Department of Radiation Oncology, Dr Bernard Verbeeten Institute, Tilburg, the Netherlands (D.C.P.C.)
| | - David C P Cobben
- From the Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology (J.P., E.G.C.T., A.L.H.), Department of Radiology (J.P., R.G.H.B.), and Department of Epidemiology (P.J.N.), Maastricht University Medical Centre, Dr. Tanslaan 12, 6229 ET Maastricht, the Netherlands; Department of Radiation Oncology, University Medical Centre, Utrecht, the Netherlands (D.C.P.C., J.C.J.d.B.); and Department of Radiation Oncology, Dr Bernard Verbeeten Institute, Tilburg, the Netherlands (D.C.P.C.)
| | - Johannes C J de Boer
- From the Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology (J.P., E.G.C.T., A.L.H.), Department of Radiology (J.P., R.G.H.B.), and Department of Epidemiology (P.J.N.), Maastricht University Medical Centre, Dr. Tanslaan 12, 6229 ET Maastricht, the Netherlands; Department of Radiation Oncology, University Medical Centre, Utrecht, the Netherlands (D.C.P.C., J.C.J.d.B.); and Department of Radiation Oncology, Dr Bernard Verbeeten Institute, Tilburg, the Netherlands (D.C.P.C.)
| | - Aswin L Hoffmann
- From the Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology (J.P., E.G.C.T., A.L.H.), Department of Radiology (J.P., R.G.H.B.), and Department of Epidemiology (P.J.N.), Maastricht University Medical Centre, Dr. Tanslaan 12, 6229 ET Maastricht, the Netherlands; Department of Radiation Oncology, University Medical Centre, Utrecht, the Netherlands (D.C.P.C., J.C.J.d.B.); and Department of Radiation Oncology, Dr Bernard Verbeeten Institute, Tilburg, the Netherlands (D.C.P.C.)
| | - Regina G H Beets-Tan
- From the Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology (J.P., E.G.C.T., A.L.H.), Department of Radiology (J.P., R.G.H.B.), and Department of Epidemiology (P.J.N.), Maastricht University Medical Centre, Dr. Tanslaan 12, 6229 ET Maastricht, the Netherlands; Department of Radiation Oncology, University Medical Centre, Utrecht, the Netherlands (D.C.P.C., J.C.J.d.B.); and Department of Radiation Oncology, Dr Bernard Verbeeten Institute, Tilburg, the Netherlands (D.C.P.C.)
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Tang W, Wu N, OuYang H, Huang Y, Liu L, Li M. The presurgical T staging of non-small cell lung cancer: efficacy comparison of 64-MDCT and 3.0 T MRI. Cancer Imaging 2015; 15:14. [PMID: 26335333 PMCID: PMC4559286 DOI: 10.1186/s40644-015-0050-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 08/27/2015] [Indexed: 11/10/2022] Open
Abstract
Background Lung cancer has been the main concern of the cancer-related deaths worldwide. Non-small cell lung cancer (NSCLC) is reported the most common subtype of lung cancer. Initial staging of NSCLC is highly associated with the choice of treatment and prognosis of the patients. This study aims to prospectively compare the diagnostic efficacies of 64-multidetector-row computed tomography (MDCT) and 3.0 T magnetic resonance imaging (MRI) in T staging of NSCLC. Methods Institutional review board approval and informed consent were obtained. Forty-five patients diagnosed with NSCLC who underwent preoperative MRI and MDCT scans were enrolled in the study. The efficacies of determination of T staging on MRI and MDCT were compared by using the McNemar test. Results Of 45 patients diagnosed with NSCLC, the primary tumors were correctly staged in 38 (84.4 %) patients on MDCT, and in 37 (82.2 %) patients on MRI. There was no statistically significant difference between the two modalities in the overall T staging of NSCLC with the reference of pathological findings (p = 0.564). However, MDCT was indicated more accurate in determination of NSCLC staged T1 and T2 (100 % vs 75 %, 96.4 % vs 82.1 %), whereas MRI was presented slightly superior in identification of NSCLC staged T3 and T4 (80 % vs 50 %, 100 % vs 33.3 %). Conclusion Both MDCT and MRI provided acceptable overall accuracies in determination of T staging in NSCLC. Furthermore, MRI was presented slight superiority for the advanced-stage tumors (i.e., NSCLC staged T3 and T4), whereas MDCT was indicated mild acceptance for the limited-stage tumors (i.e., NSCLC staged T1 and T2).
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Affiliation(s)
- Wei Tang
- Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ning Wu
- Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Han OuYang
- Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yao Huang
- Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
| | - Li Liu
- Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Meng Li
- Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Raúl Pefaur D. Imaginología actual del cáncer pulmonar. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70128-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Oliveira C, Saraiva A. Estudo comparativo do diagnóstico de câncer pulmonar entre tomografia computadorizada e broncoscopia. Radiol Bras 2010. [DOI: 10.1590/s0100-39842010000400006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
OBJETIVO: Analisar a tomografia computadorizada e a broncoscopia no diagnóstico do câncer pulmonar e verificar a eficácia destas técnicas perante a presença desta doença. Os parâmetros idade, gênero, hábitos tabágicos, tipos histológicos, estadiamento e terapêutica foram, igualmente, analisados. MATERIAIS E MÉTODOS: Foram analisados 70 pacientes do Serviço de Pneumologia do Hospital Distrital da Figueira da Foz, Coimbra, Portugal, que realizaram ambas as técnicas em estudo, tendo-se confirmado ou não a presença de câncer pulmonar. RESULTADOS: Diagnosticaram-se 37 tumores pulmonares, 23 casos no gênero masculino e 14 no feminino. Histologicamente, 40,54% eram adenocarcinomas, seguido do carcinoma escamoso (32,43% dos casos) e do carcinoma de pequenas células (18,92%). O estadiamento mostrou 6,70% no estádio IB, 23,30% no estádio IIIA comparativamente ao IIIB com 36,70%, encontrando-se 33,30% dos doentes no estádio IV. A quimioterapia isolada foi efetuada em 75,7% dos doentes. A sensibilidade da broncoscopia foi de 83,8%, a especificidade, de 81,8%, e a precisão, de 82,8%. A sensibilidade da tomografia computadorizada foi de 81,1%, a especificidade, de 63,6%, e a precisão, de 72,8%. CONCLUSÃO: Os resultados da broncoscopia confirmaram a sua importância no diagnóstico do câncer pulmonar, pela dependência deste no exame anatomopatológico do tecido ou células, obtido por várias técnicas de biópsia. A tomografia computadorizada apresentou boa sensibilidade, de 81,1%, contudo, a sua especificidade, de apenas 63,6%, resulta do número de falso-positivos (36,4%).
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Abstract
Traumatic brain injury represents a substantial public health problem for which clinicians have limited treatment avenues. Traditional FDG-positron emission tomography (PET) brain imaging has provided unique insights into this disease including prognostic information. With the advent and implementation of novel tracers as well as improvement in instrumentation, molecular brain imaging using PET can further illustrate traumatic brain injury pathophysiology and point to novel treatment strategies.
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Affiliation(s)
- Jacob G Dubroff
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Room 110, Donner Building, Philadelphia, PA 19104, USA
| | - Andrew B Newberg
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Room 110, Donner Building, Philadelphia, PA 19104, USA.
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Bryant AS, Cerfolio RJ. Diagnosis, staging and treatment of patients with non-small cell lung cancer for the surgeon. Indian J Surg 2009; 71:310-6. [PMID: 23133183 DOI: 10.1007/s12262-009-0086-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Accepted: 12/03/2009] [Indexed: 12/25/2022] Open
Abstract
This article covers the risk factors, diagnostic tools, staging methods/modalities and treatment for patients with non-small cell lung cancer (NSCLC). Also presented is the new 7th edition American Joint Cancer Committee (AJCC) TNM classification for staging of NSCLC and a recommended treatment algorithm.
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Affiliation(s)
- Ayesha S Bryant
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, 703 19th St S, ZRB 739, Birmingham, AL 35294 USA
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Katz S, Ferrara T, Alavi A, Torigian DA. PET, CT, and MR Imaging for Assessment of Thoracic Malignancy: Structure Meets Function. PET Clin 2009; 3:395-410. [PMID: 27156668 DOI: 10.1016/j.cpet.2009.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Imaging of patients with thoracic malignancy usually requires a multimodality approach. Each of these modalities has its own strengths and weaknesses. CT remains central to the staging and restaging of thoracic malignancies, but has recently been complemented with [18F]-2-fluoro-2-deoxy-D-glucose(FDG)-positron emission tomography (PET) imaging to maximize its potential. Furthermore, because FDG-PET/CT is useful at all stages of the workup and treatment of these patients, this modality has taken hold in the clinical realm for evaluation of patients with thoracic malignancy and is rapidly replacing PET-only imaging. MR imaging is also occasionally used in some patients with thoracic malignancies to improve disease staging or lesion characterization. PET/MR imaging may come to be used to evaluate patients with thoracic malignancies as well.
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Affiliation(s)
- Sharyn Katz
- Department of Radiology, Hospital of the University of Pennsylvania, School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - Thomas Ferrara
- Department of Radiology, Hospital of the University of Pennsylvania, School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Drew A Torigian
- Department of Radiology, Hospital of the University of Pennsylvania, School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Godelman A, Haramati LB. MR Imaging in Diagnosis and Staging of Pulmonary Carcinoma. Magn Reson Imaging Clin N Am 2008; 16:309-17, ix. [DOI: 10.1016/j.mric.2008.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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An unexpected abdominal 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) in a patient with limited stage small cell lung cancer. J Thorac Oncol 2008; 3:174-6. [PMID: 18303440 DOI: 10.1097/jto.0b013e318162336b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We report the case of an unexpected 18F-fluorodeoxyglucose-avid lesion in the right lower abdomen in a patient with otherwise "very limited" (T1N0) small cell lung cancer (SCLC). Additional imaging and endoscopic studies showed no abnormality. The patient was treated for presumed very limited disease SCLC, with resection, adjuvant chemotherapy, and prophylactic brain irradiation. Follow-up fusion positron emission tomography-computed tomography revealed an unusual SCLC complication.
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