Diaphragmatic and Crural FDG Uptake in Hyperventilating Patients: A Rare Pattern Important to Recognize

Chander, Subhash; Ergün, Eser Lay; Zak, Imad; Zingas, Alkis P.; Bloom, David A.; Joyrich, Richard; Getzen, T.M.; Shaman, Mark A.

doi:10.1097/01.rlu.0000122801.10066.2d

Cited by 9 publications

(5 citation statements)

References 7 publications

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“…10 Similarly, there have been a reported incidence of unilateral crural uptake on 18 F-FDG PET due to increased breathing, which was hypothesized due to increased work of breathing of the right lung secondary to restricted motion of the left hemidiaphragm due to metastatic pleural disease of the left side. 11 Albeit our patient underwent RT for Ewing's sarcoma of the paraspinal region, our patient was clinically asymptomatic at the time of 18 F-FDG scan and never had any breathing difficulties till 3 months post scan as opposed to scans elaborated by Jolepalem et al, 6 wherein benign unilateral uptake in the diaphragmatic crus was described. In case of unilateral diaphragmatic crus uptake, when the uptake is contralateral to the paralyzed hemidiaphragm, the explanation is a compensatory increase in the work of the functioning side, while for uptake on the ipsilateral side, phrenic nerve neuropathy is implicated.…”

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confidence: 57%

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18F-Fluorodeoxyglucose Uptake in Bilateral Diaphragmatic Crura: A Relatively Uncommon Benign Variant Noted in a Treated Case of Extraosseous Paraspinal Ewing's Sarcoma

Baberwal,

Sonavane,

Basu

2024

World J Nucl Med

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A toddler was diagnosed with extraosseous Ewing's sarcoma, primary large epidural paraspinal soft tissue in the lumbar region encasing the cord and neural foramen from D12–L1 to L4–L5. After eight cycles of induction chemotherapy with vincristine, doxorubicin, and cyclophosphamide alternating with etoposide and ifosfamide, 18F-FDG positron emission tomography/computed tomography (18F-FDG-PET/CT) scan confirmed no active disease. Later external beam radiotherapy (EBRT) at D10–L5 was completed. At 3 months follow-up, 18F-FDG-PET/CT reconfirmed no residual/active disease; however, a new incidental finding of diffuse benign bilateral diaphragmatic 18F-FDG uptake was noted in the clinically asymptomatic patient, which remained unexplained.

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confidence: 57%

Section: Discussionmentioning

confidence: 99%

18F-Fluorodeoxyglucose Uptake in Bilateral Diaphragmatic Crura: A Relatively Uncommon Benign Variant Noted in a Treated Case of Extraosseous Paraspinal Ewing's Sarcoma

Baberwal,

Sonavane,

Basu

2024

World J Nucl Med

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“…The high FDG uptake in these situations is typically seen bilaterally (1). Unilateral FDG uptake in the diaphragm and crura was also reported (2). However, in our patient there was no bilateral or unilateral FDG uptake in the crura of the diaphragm.…”

Section: Literature Review and Discussionmentioning

confidence: 88%

Rare Thyroid Cartilage and Diaphragm Metastases from Lung Cancer Visualized on F-18 FDG-PET/CT Imaging

Kara¹,

Gedik²,

Sarı³

et al. 2011

Mirt

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Positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG) has evolved as a useful imaging modality in the assessment of a variety of cancers, especially for tumor staging and post treatment monitoring. It provides metabolic information. Although, when used alone, relative lack of anatomic landmarks, is a major limitation of PET imaging, this limitation of PET imaging is overcome by the availability of integrated PET/CT imaging. PET and CT images are acquired in one procedure, yielding fused anatomical and functional data sets. Studies with integrated PET/CT imaging have shown promising results. In this case, we present an interesting integrated PET/CT imaging in a lung cancer patient with rare, diaphragm and thyroid cartilage metastases.Conflict of interest:None declared.

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“…Therefore, the patient's medical history is crucial in identifying the nature of diffuse FDG uptake in the spleen and avoiding confusion with benign or malignant causes. FDG uptake can be present in diaphragmatic crura in hyperventilating patients with chronic obstructive pulmonary disease; this finding can be confused with celiac or perigastic lymph node disease (17). Bone Marrow.-Diffuse extensive FDG uptake in the bone marrow is observed after administration of granulocyte colony-stimulating factor or chemotherapy.…”

Section: Normal Variations In Fdg Uptakementioning

confidence: 99%

Image-guided Biopsy: What the Interventional Radiologist Needs to Know about PET/CT

et al. 2012

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Positron emission tomography (PET)/computed tomography (CT) with fluorine 18 fluorodeoxyglucose (FDG) is increasingly used in evaluation of oncology patients. Because PET/CT can demonstrate malignancy before morphologic changes are evident, application of PET/CT information to image-guided biopsy can facilitate early histologic diagnosis and staging. However, because FDG uptake is not specific to cancer, PET/CT findings may raise questions about whether uptake in a lesion is an indication for biopsy. To properly select patients for image-guided biopsy, interventional radiologists should be familiar with the biologic significance of FDG uptake and various causes of false-positive uptake. PET/CT images may also become a source of confusion in the interpretation of biopsy results. Various causes of false-positive and false-negative FDG uptake need to be considered, especially when there is a discrepancy between biopsy results and PET/CT findings. False-negative FDG uptake can result from cancers that are too small to be observed or not FDG avid. False-positive FDG uptake can be due to underlying inflammation from recent treatment. Conversely, complete resolution of FDG uptake in a treated lesion does not necessarily indicate absence of viable cells. When questions about PET/CT findings arise in the context of image-guided biopsy, discussion with experienced nuclear imaging physicians is essential.

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Diaphragmatic and Crural FDG Uptake in Hyperventilating Patients: A Rare Pattern Important to Recognize

Cited by 9 publications

References 7 publications

18F-Fluorodeoxyglucose Uptake in Bilateral Diaphragmatic Crura: A Relatively Uncommon Benign Variant Noted in a Treated Case of Extraosseous Paraspinal Ewing's Sarcoma

18F-Fluorodeoxyglucose Uptake in Bilateral Diaphragmatic Crura: A Relatively Uncommon Benign Variant Noted in a Treated Case of Extraosseous Paraspinal Ewing's Sarcoma

Rare Thyroid Cartilage and Diaphragm Metastases from Lung Cancer Visualized on F-18 FDG-PET/CT Imaging

Image-guided Biopsy: What the Interventional Radiologist Needs to Know about PET/CT

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