Coccidioidal pulmonary nodules take up significantly less (18)FDG than those due to malignancies, but there is considerable overlap between granulomatous and malignant lesions at lower SUV(max).

of EDS or were referred for management after a diagnosis of narcolepsy was made elsewhere without urine drug screening. Our hypothesis was that tetrahydrocannabinol (THC) use can cause symptoms like EDS and may also cause false (+) MSLT consistent with narcolepsy. We also hypothesized that symptoms of narcolepsy, including EDS, cataplexy, sleep paralysis, or hypnagogic/hypnopompic hallucinations might be found in Objective: Drugs can infl uence results of multiple sleep latency tests (MSLT). We sought to identify the effect of marijuana on MSLT results in pediatric patients evaluated for excessive daytime sleepiness (EDS). Methods: This is a retrospective study of urine drug screens performed the morning before MSLT in 383 patients < 21 years old referred for EDS. MSLT results were divided into those with (1) (−) urine drug screens, (2) urine drug screens (+) for tetrahydrocannabinol (THC) alone or THC plus other drugs, and (3) urine drug screens (+) for drugs other than THC. Groups were compared with Fisher exact tests or one-way ANOVA. Results: 38 (10%) urine drug tests were (+): 14 for THC and 24 for other drugs. Forty-three percent of patients with drug screen (+) for THC had MSLT fi ndings consistent with narcolepsy, 0% consistent with idiopathic hypersomnia, 29% other, and 29% normal. This was statistically different from those with (−) screens (24% narcolepsy, 20% idiopathic hypersomnia, 6% other, 50% normal), and those (+) for drugs other than THC (17% narcolepsy, 33% idiopathic hypersomnia, 4% other, 46% normal (p = 0.01). Six percent (6/93) of patients with MSLT fi ndings consistent with narcolepsy were drug screen (+) for THC; 71% of patients with drug screen (+) for THC had multiple sleep onset REM periods (SOREMS). There were no (+) urine drug screens in patients < 13 years old. Conclusion: Many pediatric patients with (+) urine drug screens for THC met MSLT criteria for narcolepsy or had multiple SOREMs. Drug screening is important in interpreting MSLT fi ndings for children ≥ 13 years. pii: jc-00341-13 http://dx.doi.org/10.5664/jcsm.4448 E xcessive daytime sleepiness (EDS) is a frequent clinical complaint in children and adolescents seen in sleep medicine clinics. The differential diagnosis of EDS is broad and includes both narcolepsy and idiopathic hypersomnia. Diagnosis of narcolepsy and idiopathic hypersomnia is made by a clinical history followed by a standardized multiple sleep latency test (MSLT) consisting of 4-5 daytime nap opportunities conducted under a standardized protocol in which mean sleep onset latency (MSL) is calculated and the number of sleep onset rapid eye movement (REM) periods are tabulated.1 Interpretation of the MSLT fi ndings, however, can be complicated by several factors, including prior sleep deprivation, coexisting sleep disorders such as obstructive sleep apnea, prescription medications, and illicit drugs. Because of the frequency of illicit drug use, the American Academy of Sleep Medicine (AASM) standard of practice for performing an MSLT states that obtaining a mor...

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