[Insidious aspects of small pulmonary coin lesions]

After his girl friend had been diagnosed with active pulmonary tuberculosis, a 45-year old male was referred to rule out transmission of this disease. The chest x-ray showed no signs of tuberculosis, however a small retrosternal lung nodule was found on the lateral film. Three months later, the nodule showed an increase in size and a CT of the chest was performed: No nodule could be found in the expected retrosternal location, but incidentally a small nodule in the right upper lobe was identified. This nodule could retrospectively be identified on the previous chest X-rays, its size had been increasing. After surgical removal, the lesion was diagnosed to be an adenocarcinoma T1, N0, M0. Careful follow-up of small intrapulmonary nodules detected on chest X-rays is highly advisable, especially in smokers of middle and older age bronchial carcinoma and therefore a straight forward approach with excision of the nodule should be considered. Nodules have to be surgically removed if an increase in size can be noted.