A Rationale for the Use of F18-FDG PET/CT in Fever and Inflammation of Unknown Origin

Figure 3

Seventy-three year old woman with belching complaints and recurrent pain between the shoulder blades with increasing intensity. Coronary artery disease as a probable cause was excluded at the cardiology department. Laboratory revealed a CRP of 224 mg/L with an ESR of 64 mm/h. Chest radiography showed an increased cor/thorax ratio. US abdomen no abnormalities. CT of thorax and abdomen showed signs of left pleural effusion and pericardial fluid, which was considered not enough for biopsy by the cardiologist. Virus serology was negative. Histopathology of pleural fluid showed signs of inflammation, and no malignancy. Histopathology of duodenal biopsy specimen without abnormalities. F18-FDG PET/CT showed pathologic uptake in the wall of the aorta and its main branches, both thoracic and abdominal. Patient was diagnosed as having large vessel vasculitis and accordingly treated with prednisolone and became free of complaints, CRP and ESR normalized.