CASE PRESENTATION: A 52-year-old female smoker presents for evaluation of an incidental, 12x9 mm, well-circumscribed, solid right middle lobe lung nodule. Her baseline symptoms include a chronic smoker’s cough without hemoptysis or constitutional symptoms. Given intermediate pretest probability of malignancy, a positron emission tomography (PET) was performed and showed a mildly hypermetabolic nodule with no other abnormal uptake. Location of the nodule precluded bronchoscopy or CT-guided needle biopsy. The patient opted for serial radiographic follow-up instead of surgical lung biopsy. Repeat imaging demonstrated a 20% increase in size to 13x10 mm at 176 days with calculated doubling time of 666 days (Fig. 1). The patient agreed to thoracic surgery evaluation and underwent a video-assisted thoracoscopic right middle lobectomy with right hilar, interlobar, and subcarinal lymph node dissection. Pathology confirmed the diagnosis of paraganglioma (Fig. 2) with benign lymph nodes. Functional analysis for neuropeptides was unremarkable. The patient remained stable without new symptoms or recurrence on subsequent imaging.