Abstract
A 59-year-old man was referred to our hospital for further examination regarding probable interstitial pneumonia detected in a company medical examination. Chest CT revealed interstitial pneumonia, and multiple angular pulmonary nodules in the subpleural region of the bilateral lung field. It was not possible to distinguish benign from malignant lesions based on chest CT findings preoperatively. Therefore, we performed thoracoscopic partial resection of the right lower lobe. The lung specimens showed pulmonary emphysema and fibrosis with interstitial pneumonia, and reactive intrapulmonary lymph nodes with anthracotic changes. Reactive intrapulmonary lymph nodes less than 1 cm in diameter result from exposure to inflammatory changes due to pneumonia after chemotherapy, bronchial asthma, and interstitial pneumonia, on condition that small intraparenchymal pulmonary lymph nodes naturally exist in peripheral regions distal from the fourth bronchial bifurcated level. Multiple angular pulmonary nodules resulting from exposure to inflammatory changes can not be distinguished from metastatic nodules based on chest CT findings preoperatively. Therefore, a pathological study with thoracoscopic partial resection is necessary and sure procedures to exclude malignant disease under the present conditions.
