We describe a case of a symptomatic mucocele of the esophagus following surgical isolation of the diseased esophagus, which needed surgical resection. A 33-year-old male presented to us with shock, high-grade fever, and breathlessness five days after the onset of sudden, severe lower chest and upper abdominal pain preceded by an episode of retching and vomiting. He was initially managed elsewhere by right intercostal drainage for right-sided pleural effusion, broad-spectrum parenteral antibiotics, and total parenteral nutrition. CT chest showed a right loculated pleural effusion and distal oesophageal perforation with active contrast leak into the right pleural space. He was subsequently referred to us in view of suspected Boerhaave's syndrome and clinical worsening. In view of hemodynamic instability with uncontrolled sepsis, he was planned for surgery. Intraoperatively, there was a 4 cm long distal oesophageal perforation, 4 cm above the esophagogastric junction on the right, with an unhealthy apex, communicating with a large abscess cavity in the right pleural space with thick purulent contents. End cervical esophagostomy with esophagogastric junction stapling and feeding jejunostomy was performed in addition to transhiatal drainage of the abscess at the lower end of the esophagus and the placement of an additional intercostal drain. The postoperative period was uneventful, and he was discharged. After two months, he was assessed for possible How to cite this article

Introduction and AimPreliminary studies showed good expression of fibroblast activating protein inhibitor (FAPI) in hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). Our aims were to study the diagnostic performance of 68Ga-FAPI PET/CT in diagnosing the primary hepatobiliary malignancies and to compare its performance with 18F-FDG PET/CT.Patients and MethodsPatients suspected to have HCC and CC were recruited prospectively. FDG and FAPI PET/CT studies were completed within 1 week. Final diagnosis of malignancy was achieved by tissue diagnosis (either histopathological examination or fine-needle aspiration cytology) and radiological correlation from conventional modalities. Results were compared with final diagnosis and expressed as sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy.ResultsForty-one patients were included. Thirty-one were positive for malignancy and 10 were negative. Fifteen were metastatic. Of 31, 18 were CC and 6 were HCC. For overall diagnosis of the primary disease, FAPI PET/CT performed exceptionally compared with FDG PET/CT with sensitivity, specificity, and accuracy of 96.77%, 90%, and 95.12%, respectively, versus 51.61%, 100%, and 63.41% for FDG PET/CT. FAPI PET/CT clearly outperformed FDG PET/CT for the evaluation of CC with sensitivity, specificity, and accuracy of 94.4%, 100%, and 95.24%, respectively, whereas for FDG PET/CT sensitivity, specificity, and accuracy were 50%, 100%, and 57.14%, respectively. Diagnostic accuracy of FAPI PET/CT was 61.54% for metastatic HCC compared with 84.62% for FDG PET/CT.ConclusionsOur study highlights the potential role of FAPI-PET/CT in evaluating CC. It also ascertains its usefulness in the cases of mucinous adenocarcinoma. Although it showed a higher lesion detection rate than FDG in primary HCC, its diagnostic performance in the metastatic setting is questionable.