Discordant 18F-FDG and 68Ga-DOTATATE PET/CT Findings in a Case of Typical Pulmonary Carcinoid Tumor

We report a middle-aged man incidentally diagnosed with multiple pulmonary nodules during evaluation for microscopic hematuria. Subsequent imaging revealed a dominant right middle lobe nodule with multifocal bilateral pulmonary lesions. Histopathologic evaluation confirmed a typical pulmonary carcinoid tumor. Sequential functional imaging with ¹⁸ F-fluorodeoxyglucose (FDG) PET/CT and ⁶⁸ Ga-DOTATATE PET/CT demonstrated a discordant imaging phenotype, characterized by high FDG but minimal DOTATATE avidity. The patient underwent bilateral surgical resection and remains in remission. This case highlights the unexpectedly low DOTATATE uptake in typical pulmonary carcinoid tumors, and the complementary value of FDG and DOTATATE PET imaging in characterizing tumor biology, potentially guiding management.