Pleuroparenchymal fibroelastosis presenting as a hypermetabolic lung nodule.

Idiopathic pleuroparenchymal fibroelastosis is a rare, benign entity consisting of fibrotic thickening of the pleura and subpleural parenchyma due to elastic fiber proliferation. We present an elderly, male smoker with chronic obstructive airway disease and bilateral apical pleuropulmonary fibrotic changes. The computed tomogram of the chest showed a spiculated nodule in the left upper lobe and chronic fibrotic nodular changes in the right lung. A positron emission tomographic (PET) scan with 18-fluorodeoxyglucose-PET showed a hypermetabolic nodule in the left upper lobe and uptake by the left axillary lymph nodes. Surgical resection of the nodule for presumptive malignancy showed fibroelastosis with reactive lymph node hyperplasia. To our knowledge, this is the first reported case of nodular parenchymal fibroelastosis, with increased uptake as shown on a PET scan.