Polyarteritis Nodosa With Reversible FDG Accumulation in Vessels and Kidneys

Abstract

A 59-year-old man presented with fever and lower extremity myalgia. Laboratory studies revealed elevated C-reactive protein. 18F-FDG PET/CT demonstrated FDG uptake not only in the brachial arteries, femoral arteries, and their main ramifications, which were equivalent to small- to medium-sized arteries but also in the kidneys. Angiography revealed a renal aneurysm, confirming the diagnosis of polyarteritis nodosa. The increased FDG uptake in the vessels and kidneys resolved after 6 months of glucocorticoid treatment.

The "Ant-farm"-like Appearance of Restricted Lower Limb Vasculitis on Fluorodeoxyglucose-positron Emission Tomography

“…To our knowledge, there have been no previous reports demonstrating the usefulness of FDG-PET in diagnosing restricted lower limb vasculitis. Although there are a few case reports of polyarteritis nodosa showing a similar patchy FDG uptake to the present cases ( 10 - 12 ), the findings were not restricted to the lower limbs, and the presence of vasculitis was not confirmed histologically. There seem to be three possible reasons as to why the FDG-PET findings of restricted lower limb vasculitis have not been reported thus far: 1) the uptake in the lower limbs is overlooked as a non-specific finding, 2) FDG-PET is not often performed because of its high cost, and 3) the lower limbs are not routinely imaged, especially when there are no noticeable symptoms in the lower limbs.…”