一名居住在韩国的 81 岁男性因常规监测 CT 发现异常结果被转诊至肺科诊所（图 1A、1B）。他既往病史包括 2016 年因输尿管癌接受右根治性肾输尿管切除术、2015 年经尿道膀胱肿瘤切除术，以及在 30 岁时患结核性胸膜炎并并发慢性钙化脓胸（图 1C）。他的临床表现一直良好，直到 6 个月前，他因进行性右侧胸痛和呼吸困难到一家外部医院就诊，并被发现患有活动性结核病。住院期间，他接受了胸部 CT 检查，并对偶然发现的胸部病变进行了 CT 引导活检（图 2），结果显示存在慢性活动性炎症。开始抗结核药物治疗后，他的症状有所改善，并出院回家完成治疗。由于随后的 CT 监测扫描发现该病变呈间歇性生长，因此他被转诊至肺科进行进一步评估。在他访问期间获得的实验室检查显示轻度白细胞增多（1258个细胞×109/L；正常范围，4000-10 000个细胞×109/L），以中性粒细胞为主（82%中性粒细胞；正常范围，50%-75%中性粒细胞），并且C反应蛋白水平轻度升高（3.17 mg/dL；正常范围，0-0.5 mg/dL）。痰培养结核病呈阴性。患者报告有轻度胸部不适和呼吸困难。进行肝脏 MRI 进一步评估 CT 上发现的异常病变（图 3）。鉴于患者最近的非特异性活检结果和结核病治疗，没有进行进一步的检查。 6个月后，由于患者胸痛和呼吸困难加重，进行了胸部增强CT检查（图4）。他仍然没有发烧，白细胞持续增多（1485 个细胞×109/L），C 反应蛋白水平升高（3.56 mg/dL）。根据影像学检查结果，重复进行CT引导下活检和PET/CT（图5），从而确认诊断，并开始适当的治疗。

An 81-year-old man living in South Korea was referred to the pulmonology clinic because of abnormal findings at routine surveillance CT (Fig 1A, 1B). His past medical history included right radical nephroureterectomy for ureteral cancer in 2016, transurethral resection of a bladder tumor in 2015, and tuberculous pleurisy in his third decade of life that was complicated by a chronic calcified empyema (Fig 1C). He had been doing well clinically until 6 months prior, when he presented to an outside hospital with progressive right-sided chest pain and dyspnea and was found to have active tuberculosis. During that hospitalization, he underwent chest CT and CT-guided biopsy of an incidentally found thoracic lesion (Fig 2), which revealed chronic active inflammation. His symptoms improved after initiation of antituberculous medication, and he was discharged home to complete treatment. Because of interval growth of this lesion noted on a subsequent surveillance CT scan, he was referred to pulmonology for further evaluation. Laboratory tests obtained during his visit revealed mild leukocytosis (1258 cells × 109/L; normal range, 4000-10 000 cells × 109/L) with neutrophilic predominance (82% neutrophils; normal range, 50%-75% neutrophils), and a mildly elevated C-reactive protein level (3.17 mg/dL; normal range, 0-0.5 mg/dL). A sputum culture was negative for tuberculosis. The patient reported mild chest discomfort and dyspnea. Liver MRI was performed to further evaluate an abnormal lesion seen at CT (Fig 3). Given the patient's recent nonspecific biopsy results and tuberculosis treatment, no further work-up was pursued. Contrast-enhanced chest CT was performed 6 months later because the patient developed worsening chest pain and dyspnea (Fig 4). He remained afebrile, with persistent leukocytosis (1485 cells × 109/L) and an elevated C-reactive protein level (3.56 mg/dL). On the basis of the imaging findings, repeat CT-guided biopsy and PET/CT were performed (Fig 5), thereby enabling confirmation of the diagnosis, and appropriate treatment was initiated.