Surgical biopsy prevented with PET/CT scan in a young female with intrathoracic lymphadenopathy

Intrathoracic lymphadenopathy is a common clinical problem encountered in Histoplasma endemic zones. It is challenging for clinicians to distinguish the infectious lesions from the neoplastic ones. Bronchoscopy with or without lung sampling and transbronchial needle aspiration (TBNA) is commonly the first diagnostic procedure employed. If non-diagnostic, the next step is usually surgical biopsy. In our experience, a significant number of patients who go for surgical biopsy are diagnosed with histoplasmosis. A positron emission tomography (PET) scan with dual-time imaging may help us distinguish benign from malignant lesions, thus obviating the need for surgical sampling. We report a case of a young female who presented with progressively increasing intrathoracic lymphadenopathy and was treated successfully based on dual-time PET scan results, without proceeding to surgical lung biopsy.