Tumor Thrombus in the Renal Vein from an Adrenal Metastasis of Lung Cancer: 18FDG PET/CT Findings

Abstract

Tumor thrombus is a rare complication of solid cancer. The authors report a case of a 76-year-old woman presenting a thick walled cystic mass in the lower lobe of the left lung. 18FDG positron emission tomography (PET)/computed tomography (CT) was performed, showing tracer accumulation in the wall of the pulmonary lesion and in the mediastinal and hilar lymph nodes. Moreover, PET/CT depicted a gross mass in the left adrenal gland and a hypermetabolic focus corresponding to the anatomic location of the left renal vein. Contrast-enhanced CT, subsequently performed, confirmed PET findings in the lung, lymph nodes, and adrenal glands, also demonstrating marginal enhancement and intraluminal filling defect in the left renal vein, which was interpreted as tumor thrombus due to the 18FDG uptake at PET scan. CT-guided biopsy of the mass was positive for poorly differentiated carcinoma. 18FDG PET can be useful to diagnose tumor thrombus in oncological patients.

Development of Adrenal Cortex Zonation

“…Perhaps due to the energy intensive nature of steroidogenesis, the adrenal glands have one of the greatest blood supplies per gram of tissue of any organ, with up to 60 arterioles entering each adrenal gland. This may account for the high prevalence of cancer metastases found in the adrenal gland 82–84 . Arterial blood first reaches the outer surface of adrenal cortex where the cortical arteries branch to form the subcapsular capillary plexus 85 .…”