Background Lung involvement in patients with coronavirus disease 2019 (COVID-19) undergoing PET-CT has been previously reported. However, FDG uptake outside lung parenchyma was poorly characterized in detail. We evaluated the extraparenchymal lung involvement in asymptomatic cancer patients with COVID-19 pneumonia through 18 F-FDG PET-CT. Methods A total of 1079 oncologic 18 F-FDG PET-CT were performed between February 2 and May 18, 2020. Confirmed COVID-19 pneumonia was defined as characteristic ground-glass bilateral CT infiltrates and positive genetic/serologic tests. Nonmetastatic extra-parenchymal lung PET-CT findings were evaluated through qualitative (visual), quantitative (measurements on CT), and semiquantitative (maximum standardized uptake value: SUVmax on PET) interpretation. Clinical data, blood tests, and PET-CT results were compared between patients with and without COVID-19 pneumonia. Results A total of 23 18 F-FDG PET-CT scans with pulmonary infiltrates suggestive of COVID-19 and available laboratory data were included: 14 positive (cases) and 9 negative (controls) for COVID-19 infection, representing a low prevalence of COVID-19 pneumonia (1.3%). Serum lactate dehydrogenase and D-dimers tended to be increased in COVID-19 cases. Extraparenchymal lung findings were found in 42.9% of patients with COVID-19, most frequently as mediastinal and hilar nodes with 18 F-FDG uptake (35.7%), followed by incidental pulmonary embolism in two patients (14.3%). In the control group, extrapulmonary findings were observed in a single patient (11.1%) with 18 F-FDG uptake located to mediastinal, hilar, and cervical nodes. Nasopharyngeal and hepatic SUVmax were similar in both groups. Conclusion In cancer patients with asymptomatic COVID-19 pneumonia, 18 F-FDG PET-CT findings are more frequently limited to thoracic structures, suggesting that an early and silent distant involvement is very rare. Pulmonary embolism is a frequent and potentially severe finding raising special concern. PET-CT can provide new pathogenic insights about this novel disease.

Cancer patients require a careful clinical follow-up during the coronavirus disease 2019 (COVID-19) pandemic. Although hybrid fluorine-18 Fluorodeoxyglucose ( 18 F-FDG) positron emission tomography-computed tomography (PET/CT) is not routinely used in the management of COVID-19 patients, it could play a complementary role of other laboratory and radiological data in selected cases. We describe an asymptomatic cancer patient derived to 18 F-FDGPET/CT with simultaneous findings of COVID-19 pneumonia and pulmonary thrombus, discussing its possible mechanisms and prognostic implications.

This was the case of a 61-year-old woman with a medical history significant for hypertension and rheumatoid arthritis treated with chloroquine for the last 10 years. She was admitted to our hospital for heart failure symptoms. Echocardiography revealed severe concentric left ventricular hypertrophy. Serum and urine immunofixation electrophoresis and serum light chain assay were negative. No late gadolinium enhancement was observed on cardiovascular magnetic resonance. 99mTc-99mTc-DPD (3,3-diphosphono-1,2-propanodicarboxylic acid) scintigraphy showed myocardial uptake (Perugini score 2/3). Genetic testing excluded hereditary transthyretin cardiac amyloidosis. Endomyocardial biopsy analysis did not show findings suggestive of amyloidosis but consistent with chloroquine toxicity. Chloroquine-mediated cardiotoxicity is rare, and there are very few reports about bone scintigraphy imaging features.

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