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Fluorodeoxyglucose positron emission tomography/computed tomography findings in nodular hepatic and splenic sarcoidosis.

Agrawal K, Chawla YK, Bhattacharya A, Mittal BR - World J Nucl Med (2014)

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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Dear Editor, A 62-year-old male patient presented with the chief complaint of loss of weight of 1 year duration... There was no history of associated fever... Computed tomography (CT) of abdomen revealed multiple hypo-attenuating lesions in the liver and spleen... The patient underwent F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT scan [Figure 1a] for characterization of the hepato-splenic lesions... PET/CT scan showed heterogeneous pattern of tracer uptake in the enlarged liver measuring approximately 18 cm in cranio-caudal direction with increased tracer uptake (SUVmax 9.7) in the hypo-attenuating lesions [arrow in the Figure 1b and c]... Furthermore, simultaneous hepato-splenic involvement and no other abnormal tracer activity anywhere, except liver, spleen and lymphadenopathy makes diagnosis of metastatic disease less likely... Increased FDG accumulation has been reported in literature in sarcoidosis... Increased metabolism in more unusual sites like liver and spleen, may mimic lymphoma or metastatic disease... However, this unique case may serve as template for pattern recognition in hepatic and splenic sarcoidosis... Thus in patients with hypermetabolic hypo-attenuating lesions in the liver and spleen with associated hypermetabolic lymphadenopathy, possibility of sarcoidosis may be considered, even if pulmonary involvement is absent.

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Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography maximum intensity projection image (a) heterogeneous tracer uptake in the enlarged liver with increased tracer uptake (SUVmax 9.7) in the hypo-attenuating lesions (arrow in b and c). Increased FDG uptake with SUVmax 7.3 is also noted in the multiple well defined hypo-dense nodules of variable sizes in the normal sized spleen (b and c). Multiple enlarged FDG avid mediastinal (d and e) lymph nodes are also seen
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Figure 1: Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography maximum intensity projection image (a) heterogeneous tracer uptake in the enlarged liver with increased tracer uptake (SUVmax 9.7) in the hypo-attenuating lesions (arrow in b and c). Increased FDG uptake with SUVmax 7.3 is also noted in the multiple well defined hypo-dense nodules of variable sizes in the normal sized spleen (b and c). Multiple enlarged FDG avid mediastinal (d and e) lymph nodes are also seen

Mentions: A 62-year-old male patient presented with the chief complaint of loss of weight of 1 year duration. There was no history of associated fever. On evaluation, patient had liver parenchymal disease with raised serum alkaline phosphatase. Computed tomography (CT) of abdomen revealed multiple hypo-attenuating lesions in the liver and spleen. The patient underwent F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT scan [Figure 1a] for characterization of the hepato-splenic lesions. PET/CT scan showed heterogeneous pattern of tracer uptake in the enlarged liver measuring approximately 18 cm in cranio-caudal direction with increased tracer uptake (SUVmax 9.7) in the hypo-attenuating lesions [arrow in the Figure 1b and c]. Increased FDG uptake with SUVmax 7.3 was also noted in the multiple well-defined hypo-dense nodules of variable sizes (largest measuring 1.8 cm) in the normal sized spleen [Figure 1b and c]. Increased tracer uptake was seen in right level III cervical, multiple enlarged mediastinal [Figure 1d and e] and abdominal lymph nodes. There was no abnormal lung uptake in the scan. In the given clinical context, differential diagnosis of lymphoma or granulomatous disease was made. The biopsy from the liver showed granulomas. Serum angiotensin converting enzyme (ACE) was also raised on further evaluation, thus indicative of sarcoidosis.


Fluorodeoxyglucose positron emission tomography/computed tomography findings in nodular hepatic and splenic sarcoidosis.

Agrawal K, Chawla YK, Bhattacharya A, Mittal BR - World J Nucl Med (2014)

Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography maximum intensity projection image (a) heterogeneous tracer uptake in the enlarged liver with increased tracer uptake (SUVmax 9.7) in the hypo-attenuating lesions (arrow in b and c). Increased FDG uptake with SUVmax 7.3 is also noted in the multiple well defined hypo-dense nodules of variable sizes in the normal sized spleen (b and c). Multiple enlarged FDG avid mediastinal (d and e) lymph nodes are also seen
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150160&req=5

Figure 1: Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography maximum intensity projection image (a) heterogeneous tracer uptake in the enlarged liver with increased tracer uptake (SUVmax 9.7) in the hypo-attenuating lesions (arrow in b and c). Increased FDG uptake with SUVmax 7.3 is also noted in the multiple well defined hypo-dense nodules of variable sizes in the normal sized spleen (b and c). Multiple enlarged FDG avid mediastinal (d and e) lymph nodes are also seen
Mentions: A 62-year-old male patient presented with the chief complaint of loss of weight of 1 year duration. There was no history of associated fever. On evaluation, patient had liver parenchymal disease with raised serum alkaline phosphatase. Computed tomography (CT) of abdomen revealed multiple hypo-attenuating lesions in the liver and spleen. The patient underwent F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT scan [Figure 1a] for characterization of the hepato-splenic lesions. PET/CT scan showed heterogeneous pattern of tracer uptake in the enlarged liver measuring approximately 18 cm in cranio-caudal direction with increased tracer uptake (SUVmax 9.7) in the hypo-attenuating lesions [arrow in the Figure 1b and c]. Increased FDG uptake with SUVmax 7.3 was also noted in the multiple well-defined hypo-dense nodules of variable sizes (largest measuring 1.8 cm) in the normal sized spleen [Figure 1b and c]. Increased tracer uptake was seen in right level III cervical, multiple enlarged mediastinal [Figure 1d and e] and abdominal lymph nodes. There was no abnormal lung uptake in the scan. In the given clinical context, differential diagnosis of lymphoma or granulomatous disease was made. The biopsy from the liver showed granulomas. Serum angiotensin converting enzyme (ACE) was also raised on further evaluation, thus indicative of sarcoidosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Dear Editor, A 62-year-old male patient presented with the chief complaint of loss of weight of 1 year duration... There was no history of associated fever... Computed tomography (CT) of abdomen revealed multiple hypo-attenuating lesions in the liver and spleen... The patient underwent F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT scan [Figure 1a] for characterization of the hepato-splenic lesions... PET/CT scan showed heterogeneous pattern of tracer uptake in the enlarged liver measuring approximately 18 cm in cranio-caudal direction with increased tracer uptake (SUVmax 9.7) in the hypo-attenuating lesions [arrow in the Figure 1b and c]... Furthermore, simultaneous hepato-splenic involvement and no other abnormal tracer activity anywhere, except liver, spleen and lymphadenopathy makes diagnosis of metastatic disease less likely... Increased FDG accumulation has been reported in literature in sarcoidosis... Increased metabolism in more unusual sites like liver and spleen, may mimic lymphoma or metastatic disease... However, this unique case may serve as template for pattern recognition in hepatic and splenic sarcoidosis... Thus in patients with hypermetabolic hypo-attenuating lesions in the liver and spleen with associated hypermetabolic lymphadenopathy, possibility of sarcoidosis may be considered, even if pulmonary involvement is absent.

No MeSH data available.


Related in: MedlinePlus