Atypical Presentation of COVID-19 Incidentally Detected at 18F-FDG PET/CT in an Asymptomatic Oncological Patient

Manole

Medicine and Pharmacy Reports

et al. 2020

Background. The aim of the study was to present the PET/CT imaging features in a small series of asymptomatic patients with known cancer pathologies, infected with the SARS-CoV-2 virus, which were incidentally discovered during their monitoring scan of F18-FDG PET/CT. Methods. We included in our study a number of five cases (3 female and 2 male) out of 478 patients examined by F18-FDG PET/CT between March – April 2020, with confirmed diagnostic of cancer. Four patients had lung damages suggestive for the mentioned viral infection and 1 patient had multiple lung metastases from thyroid cancer. All patients were asymptomatic for acute respiratory disease at the time of examination, being subsequently confirmed for the viral infection by specific PCR analysis. Results. The asymptomatic positive SARS-CoV-2 cancer patients discovered incidentally in PET/CT F18-FDG represent 0.83% and their imaging characteristics were suggestive for high FDG activity in the lung despite the lack of respiratory symptoms. Conclusion. The SARS CoV-2 viral infection in asymptomatic cancer patients is a very rare possibility, but represents a challenging scenario both for the differential diagnosis in cancer and also for the epidemiologic context.

Section: Discussionsupporting

confidence: 90%

Asymptomatic COVID–19 cancer patients incidentally discovered during F18-FDG PET/CT monitoring

Manole

Medicine and Pharmacy Reports

et al. 2020

Seminars in Nuclear Medicine

“…A number of studies published in the ensuing weeks concordantly reported similar incidental pulmonary findings in otherwise asymptomatic or mildly symptomatic patients who received 18 F-FDG PET/CT for oncologic indications, many of whom also demonstrated nodal involvement. 40 , 73 , 74 , 75 , 76 , 77 , 78 , 79 These and other reports were recently quantified in a systematic review by Rafiee et al which reported a mean SUV max of 4.9 ± 2.3 in COVID-19-associated pulmonary lesions. 11 Representative images of characteristic lesions are pictured in Figure 4 , Fig.…”

Section: Petmentioning

confidence: 82%

Imaging of COVID-19: CT, MRI, and PET

Fields

Demirjian

Dadgar

et al. 2021

Soon after reports of a novel coronavirus capable of causing severe pneumonia surfaced in late 2019, expeditious global spread of Severe Acute Respiratory Distress Syndrome Coronavirus 2 (SARS-CoV-2) forced the World Health Organization to declare an international state of emergency. Although best known for causing symptoms of upper respiratory tract infection in mild cases and fulminant pneumonia in severe disease, Coronavirus Disease 2019 (COVID-19) has also been associated with gastrointestinal, neurologic, cardiac, and hematologic presentations. Despite concerns over poor specificity and undue radiation exposure, chest imaging nonetheless remains central to the initial diagnosis and monitoring of COVID-19 progression, as well as to the evaluation of complications. Classic features on chest CT include ground-glass and reticular opacities with or without superimposed consolidations, frequently presenting in a bilateral, peripheral, and posterior distribution. More recently, studies conducted with MRI have shown excellent concordance with chest CT in visualizing typical features of COVID-19 pneumonia. For patients in whom exposure to ionizing radiation should be avoided, particularly pregnant women and children, pulmonary MRI may represent a suitable alternative to chest CT. Although PET imaging is not typically considered among first-line investigative modalities for the diagnosis of lower respiratory tract infections, numerous reports have noted incidental localization of radiotracer in parenchymal regions of COVID-19-associated pulmonary lesions. These findings are consistent with data from Middle East Respiratory Syndrome-CoV cohorts suggesting an ability for 18 F-FDG PET to detect subclinical infection and lymphadenitis in subjects without overt clinical signs of infection. Though highly sensitive, use of PET/CT for primary detection of COVID-19 is constrained by poor specificity, as well as considerations of cost, radiation burden, and prolonged exposure times for imaging staff. Even still, decontamination of scanner bays is a time-consuming process, and proper ventilation of scanner suites may additionally require up to an hour of downtime to allow for sufficient air exchange. Yet, in patients who require nuclear medicine investigations for other clinical indications, PET imaging may yield the earliest detection of nascent infection in otherwise asymptomatic individuals. Especially for patients with concomitant malignancies and other states of immunocompromise, prompt recognition of infection and early initiation of supportive care is crucial to maximizing outcomes and improving survivability.

Journal of Community Hospital Internal Medicine Perspectives

“…Over the last three months, a few case reports have also been published which describe asymptomatic nature of this disease in patients where this infection was detected incidentally. One of these reports describes an oncology patient in whom pulmonary findings concerning for COVID 19 were radiologically identified while undergoing workup for lymphoma [2].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic dilemma, an incidental diagnosis of COVID 19

Singh

2020

COVID 19 or SARS-CoV-2 infection was first reported in December 2019 in Wuhan City of China. Since then, it continues to spread globally and has been declared a pandemic. These patients present predominantly with respiratory complaints; however, in this article, we describe a case that was detected incidentally during workup of another suspecting diagnosis. We also elaborate on the benefits and importance of rapid testing.