18-FDG pseudotumoral lesion with quick flowering to a typical lung CT COVID-19

Abstract

As coronavirus pandemic continues to spread over the world, physicians have to be aware of atypical features of COVID-19 pneumonia. We report the case of a 78-year-old man presenting with pseudo-tumoral focal lesion of the left lung which switched shortly to severe and diffuse COVID-19 induced pneumonia. Nuclear medicine physicians and radiologists should be careful of some misleading hypermetabolic aspects mostly in asymptomatic patients.

Inflammatory response in lungs and extrapulmonary sites detected by [18F] fluorodeoxyglucose PET/CT in convalescing COVID-19 patients tested negative for coronavirus

“…The high [ 18 F] FDG uptake that characterized COVID-19 lung lesions is similar to the Middle East respiratory syndrome, H1N1 pandemic influenza virus, and organized pneumonia [30][31][32]. In addition, sometimes the lung lesions of COVID-19 may mimic tumor in PET/CT images [33]. Thus, in the midst of a COVID-19 pandemic, clinicians and radiologists have to be aware of potential misleading indications on PET/CT images.…”

“…Thus, in the midst of a COVID-19 pandemic, clinicians and radiologists have to be aware of potential misleading indications on PET/CT images. The lung lesions of COVID-19 should be differentiated from bacterial, viral, or organized pneumonia, as well as tumor [33]. Furthermore, [ 18 F] FDG PET/CT can detect inflammatory effects focusing not only on lung lesions but also on extrapulmonary sites that have been reported to be involved such as the lymph node and spleen [15].…”

Pulmonary Findings of [18F]FDG PET/CT Images on Asymptomatic COVID-19 Patients

“…In total, 30 asymptomatic patients with COVID-19 were identified in the eighteen articles. [12][13][14][15][16][17][18][19][20][21][22][23][24]; 13.33% (4/30) from North America (USA and Canada) [25][26][27][28]; and 3.33% (1/30) from Iran [29]. Of the total, 83.33% (25/30) were oncological patients who received [ 18 F]FDG PET/CT under clinical indications for staging, restaging, follow-up, and for the evaluation of therapeutic response [12][13][14][15][16][18][19][20][21][22][23][24][25]27,28].…”

“…All patients were asymptomatic for COVID-19 at time of [ 18 F]FDG PET/CT imaging. [12,13,15,18,22], primary carcinoma alone (n = 5: P2, 17, 20, 22, and 29) [19,[22][23][24], inflammatory tissues (n = 2: P3 and 30) [17,25], metastatic site (n = 2: P4 and 13) [12,27], primary carcinoma mixed metastatic site (n = 1: P7) [14], and primary carcinoma mixed non-thoracic lymph node (n = 1: P6) [28].…”

“…As the radiologists had insufficient experience in COVID-19 imaging on [ 18 F]FDG PET/CT, two patients (P5 and P6) from hospitals in Italy were not immediately confirmed by laboratory COVID-19 testing [16,21]. This also happened to P30 at another hospital in Spain [17]. P6 and P30 were confirmed to have SARS-CoV-2 infection later due to symptom onset.…”