Table of Contents
Lung Cancer International
Volume 2013, Article ID 683582, 6 pages
Clinical Study

Potential Pitfall in the Assessment of Lung Cancer with FDG-PET/CT: Talc Pleurodesis Causes Intrathoracic Nodal FDG Avidity

Department of Radiology, Division of Thoracic Imaging, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA

Received 14 February 2013; Revised 28 April 2013; Accepted 5 May 2013

Academic Editor: Giovanni Luca Ceresoli

Copyright © 2013 Yingbing Wang et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. Talc pleurodesis is a common procedure performed to treat complications related to lung cancer. The purpose of our study was to characterize any thoracic nodal findings on FDG PET/CT associated with prior talc pleurodesis. Materials and Methods. The electronic medical record identified 44 patients who underwent PET/CT between January 2006 and December 2010 and had a history of talc pleurodesis. For each exam, we evaluated the distribution pattern, size, and attenuation of intrathoracic lymph nodes and the associated standardized uptake value. Results. High-attenuation intrathoracic lymph nodes were noted in 11 patients (25%), and all had corresponding increased FDG uptake (range 2–9 mm). Involved nodal groups were anterior peridiaphragmatic (100%), paracardiac (45%), internal mammary (25%), and peri-IVC (18%) nodal stations. Seven of the 11 patients (63%) had involvement of multiple lymph nodal groups. Mean longitudinal PET/CT and standalone CT followups of months showed persistence of both high-attenuation and increased uptake at these sites, without increase in nodal size suggesting metastatic disease involvement. Conclusions. FDG avid, high-attenuation lymph nodes along the lymphatic drainage pathway for parietal pleura are a relatively common finding following talc pleurodesis and should not be mistaken for nodal metastases during the evaluation of patients with history of lung cancer.