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Confused about PET/CT results

I am 47 years old and underwent a CT scan of my abdomen for some stomach issues. A 1.4 cm nodule in the right lower lobe of my lung was found. A CT with contrast read this to be spiculated. Pulmonologist said he wasn't convinced it was spiculated and ordered a PET/CT scan. The impression was solitary small low-attenuation nonspiculated pulmonary nodule of the right lower lobe, displaying mild hypermetabolic radiotracer uptake (average SUV measurement of 2.1), accompanied by two low-attenuation lymph nodes along the subcarinal and right hilar nodal chains, displaying moderate hypermetabolic radiotracer uptake (reaching average SUV measurement of 5.7 and 6.5, respectively), collectively reflecting the "flip-flop fungus" sign, highly suggestive of chronic histoplasmosis. I just received my results from the histoplasmosis testing and they were negative. Now I am sitting and waiting for the doctor to get back to me with the next step. Could this still be benign?
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15695260 tn?1549593113
Hello and welcome to the forum.  Thank you for your question.  I'm sure this is a stressful time for you.  Has your doctor followed up yet to interpret the results?  With regards to the nodule, size really does matter.  Small nodules are more indicative of benign causes.  Keep that in mind.  This article is fairly detailed and long but does have information regarding how nodules are examined, what they look for to make a determination between benign or malignant.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5825309/  Please let us know what your doctor says and we'll go from there.  
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Avatar universal
On PET/CT, the flip-flop fungus sign describes a situation when the draining lymph node(s) are hotter than the pulmonary nodule(s), usually a sign of benignity, such as granulomatous disease, mostly histoplasmosis, but not always. In terms of what to do next, that is a conversation you will need to have with your doctor. He/she may consider close interval follow-up imaging, or alternatively biopsy, depending on your clinical and/or laboratory scenario.
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