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case_images: (A) Chest X-ray demonstrated tumor-like lesions in both lungs. (B) Chest computed tomography scan at the first examination demonstrated mediastinal and hilar lymph node swelling, bilateral tumor-like lesions, and granular shadows.
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case_images: The patient was a 78-year-old Japanese male with no history of smoking who visited our hospital with complaints of increasing dyspnea and bilateral abnormal shadows on a routine chest X-ray (Fig. 1A). Chest CT revealed mediastinal and hilar lymph node swelling, bilateral tumor-like lesions, and granular shadows (Fig. 1B).
case_images: (A) Pretreatment FDG-PET/CT demonstrated multiple areas of uptake in the lungs, lymph nodes (cervical, supraclavicular, mediastinal, hilar, paraaortic, iliac, and inguinal lymph nodes), and multiple bones (thoracic vertebrae, lumbar vertebrae, and pelvic bone). (B) Pretreatment bone scintigraphy demonstrated uptake in the lumbar vertebrae and left carpal bone.
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case_images: FDG-PET/CT revealed multiple areas of uptake in the lungs, multiple lymph nodes (cervical, supraclavicular, mediastinal, hilar, paraaortic, iliac, and inguinal lymph nodes), and multiple bones (thoracic vertebrae, lumbar vertebrae, and pelvic bone) (Fig. 2A). Bone scintigraphy revealed uptake in the lumbar vertebrae and in the left carpal bone, which was not observed in the usual FDG-PET/CT scan (Fig. 2B).
case_images: Hematoxylin-and-eosin staining demonstrated noncaseating epithelioid cell granulomas with multinucleated giant cells on lung and fibro connective tissues (area surrounded by yellow frame). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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case_images: Transbronchial lung biopsy performed on the left upper lobe revealed noncaseating epithelioid cell granulomas with multinucleated giant cells on lung tissues and fibro connective tissues (Fig. 3).
case_images: (A) After treatment, FDG-PET/CT indicated that the shadows in the lung field had decreased, and the uptake of bone lesions had almost disappeared. (B) After treatment, bone scintigraphy demonstrated decreased uptake of bone lesions.
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case_images: Follow-up FDG-PET/CT indicated that the shadows in the lung field had decreased, and the uptake of bone lesions had almost disappeared (Fig. 4A). Bone scintigraphy also demonstrated decreased uptake of bone lesions (Fig. 4B).