A young gentleman with suspected cardiac sarcoidosis and LV dysfunction whose CMR revealed multifocal subepicardial to mid myocardial linear enhancement in the left ventricular myocardium underwent cardiac 18F-FDG PET imaging. The images revealed patchy regions of increased FDG uptake involving the apical to mid anterolateral, mid to basal anteroseptal/ right ventricular and mildly increased FDG uptake in apical inferior segments of the LV myocardium concordant with CMR findings. Whole body PET CT imaging showed multiple hypermetabolic supra and infra diaphragmatic lymphadenopathy, with no pulmonary lesion identified. Biopsy from the left para aortic lymph node revealed necrotizing granulomatous inflammation consistent with tuberculosis. Based on the histopathological findings of the lymph nodes, diagnosis of cardiac tuberculosis was made, given the similar imaging appearances in both sarcoidosis and TB. This case highlights that cardiac TB although rare, should be included in the differential diagnosis in patients with suspected infiltrative cardiomyopathy, particularly in TB endemic regions.

A 50-year-old man with carcinoma of the right buccal mucosa underwent staging whole-body 18F-fluorodeoxyglucose positron emission tomography–computed tomography, which revealed a hypermetabolic heterogeneously enhancing lobulated primary lesion in the right buccal region and an incidental finding of subacute stroke. The case highlights the importance of discriminating brain neoplasms mimicking stroke from true ischemic stroke, which is crucial for appropriate management of patients in an oncology setting.

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Background: In workup for a tumor in an individual, a second pathology is discovered at times, which can complicate further management. Cross-sectional imaging is widely utilized in gastrointestinal tumors leading to identification of incidentalomas, and we audited our multidisciplinary team (MDT) meeting data in order to analyze the implications and refine the approach in the presence of dual pathology. Materials and Methods: This study was a retrospective assessment of a prospectively maintained single institute gastrointestinal tumor board MDT database between June 2019 and June 2020. Results: Of the 76 patients discussed in the gastrointestinal MDT, 21 patients associated with clinically relevant second pathology were included in the study group. Positron emission tomography–computed tomography (PET-CT) was the most common modality responsible for detection of the second pathology. Additional workup to better characterize these findings was needed in 10 (47.6%) patients. Eleven patients had dual neoplasms, of which four accounted for dual malignant neoplasms. MDT resulted in a change in plan in 6 (28.6%) patients, which was mainly related to radiology review, thereby downstaging to the correct stage. Conclusions: PET-CT increases detection of a second pathology in gastrointestinal tumors. Appropriate review of radiology, supplementing with additional imaging and/or biopsy, and wait and reassess in selected situations in an MDT is pivotal in management of a double pathology.