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Disseminated nocardia infection mimicking malignancy on FDG PET/CT
Infección diseminada por nocardia imitando malignidad en FDG PET/TC
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(A) Vascular phase, showing good perfusion without morphological changes. (B) Elimination phase, revealing a patent urachus with a functional “urachal bladder” (red arrow), without significant activity being observed in the urinary bladder (white arrow).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Sánchez Aguilar, F.J. García Gómez, J.I. Cuenca Cuenca, J.L. Tirado Hospital, F. de la Cerda Ojeda, A. Sánchez Moreno" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Sánchez Aguilar" ] 1 => array:2 [ "nombre" => "F.J." "apellidos" => "García Gómez" ] 2 => array:2 [ "nombre" => "J.I." "apellidos" => "Cuenca Cuenca" ] 3 => array:2 [ "nombre" => "J.L." "apellidos" => "Tirado Hospital" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "de la Cerda Ojeda" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Sánchez Moreno" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X15000025?idApp=UINPBA00004N" "url" => "/2253654X/0000003400000004/v1_201506220006/S2253654X15000025/v1_201506220006/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2253654X1400211X" "issn" => "2253654X" "doi" => "10.1016/j.remn.2014.11.006" "estado" => "S300" "fechaPublicacion" => "2015-07-01" "aid" => "662" "copyright" => "Elsevier España, S.L.U. and SEMNIM" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2015;34:266-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 571 "formatos" => array:3 [ "EPUB" => 13 "HTML" => 349 "PDF" => 209 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting image</span>" "titulo" => "Intestinal metastases as an unusual presentation of a burned-out testicular seminoma: PET/CT imaging" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "266" "paginaFinal" => "267" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Presentación inusual como metástasis intestinales de un seminoma testicular con regresión espontánea" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 759 "Ancho" => 1900 "Tamanyo" => 255627 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Composite PET/CT image (sequences from left to right: axial, sagittal and coronal views) showing the hypermetabolic proximal duodenal mass with two additional <span class="elsevierStyleSup">18</span>F-FDG-avid lesions at the distal duodenum and jejunum (arrows), not conspicuous on the initial CT.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "B.D. Nguyen, M.C. Roarke, M. Yang" "autores" => array:3 [ 0 => array:2 [ "nombre" => "B.D." "apellidos" => "Nguyen" ] 1 => array:2 [ "nombre" => "M.C." "apellidos" => "Roarke" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Yang" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X1400211X?idApp=UINPBA00004N" "url" => "/2253654X/0000003400000004/v1_201506220006/S2253654X1400211X/v1_201506220006/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting image</span>" "titulo" => "Disseminated nocardia infection mimicking malignancy on FDG PET/CT" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "268" "paginaFinal" => "269" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R.U. Erdemir, T. Elri, H. Sahin, Y. Sami Salihoglu, M. Aras, M. Cabuk" "autores" => array:6 [ 0 => array:3 [ "nombre" => "R.U." "apellidos" => "Erdemir" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "T." "apellidos" => "Elri" "email" => array:1 [ 0 => "tarikelri@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "H." "apellidos" => "Sahin" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Y." "apellidos" => "Sami Salihoglu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "M." "apellidos" => "Aras" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "M." "apellidos" => "Cabuk" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Nuclear Medicine, Bulent Ecevit University, School of Medicine, Zonguldak, Turkey" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Internal Medicine, Bulent Ecevit University, School of Medicine, Zonguldak, Turkey" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infección diseminada por nocardia imitando malignidad en FDG PET/TC" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 985 "Ancho" => 1950 "Tamanyo" => 215159 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">FDG PET/CT images showed intense hypermetabolic mass lesion in the right upper lobe (3.5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm) (SUVmax: 12.0) (A: Maximum intensity projection (MIP) image, B: axial PET, CT and fusion PET/CT images), multiple moderate-intense hypermetabolic parenchymal nodules in both lungs (SUVmax: 6.5) (A, C) and moderate-intense hypermetabolic multiple soft-tissue lesions (SUVmax: 10.7) in the right teres minor, bilateral gluteus medius, right erector spinae, left trapezius, right quadriceps femoris, right adductor magnus, left adductor longus muscles and subcutaneous tissue (A, D).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 39-year-old male patient was admitted to our hospital with recurrent fever and coughing up purulent sputum for two months. The symptoms were suppressed by a course of 14-day antibiotherapy (ampicillin sulbactam and clarithromycin) but relapsed after he stopped using antibiotics. The patient's past medical history included immunosuppressive therapy for Neuro-Behçet's disease 2 months ago. Laboratory work-up showed increased white blood cell count [20<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9<span class="elsevierStyleHsp" style=""></span></span>L<span class="elsevierStyleSup">–1</span> (N: 4–11<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9<span class="elsevierStyleHsp" style=""></span></span>L<span class="elsevierStyleSup">–1</span>)], C-reactive protein (CRP) concentration [128<span class="elsevierStyleHsp" style=""></span>mg/L (N: <3<span class="elsevierStyleHsp" style=""></span>mg/L)] and erythrocyte sedimentation rate (ESR) [44<span class="elsevierStyleHsp" style=""></span>mm/h (N: <5<span class="elsevierStyleHsp" style=""></span>mm/h)]. Thorax computed tomography (CT) revealed a mass in the apical segment of the upper lobe of the right lung and multiple parenchymal nodules in both lungs (not shown). Infection and malignancy were included in the differential diagnosis. An initial diagnosis of pulmonary infection was made. Since the lesions did not disappear on the follow-up CT after antibiotherapy (not shown), FDG PET/CT was requested to exclude malignancy. It showed intense hypermetabolic pleural based mass in the right upper lobe (SUVmax<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>12) and multiple nodules in both lungs (SUVmax<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6.5) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Moderate-intense hypermetabolic (SUVmax<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>10.7) soft-tissue lesions were also detected in the muscles and subcutaneous tissue (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Moreover, non-specific increased FDG uptake was observed in the spleen (SUVmax<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4.0) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The mass in the right lung and soft-tissue lesion in the right gluteal muscle were biopsied and cultured. The results were reported as nocardia infection. Nocardiosis is a rare but severe pyogenic infection that is most commonly found in immunocompromised patients.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> Pulmonary disease is the most common presentation and approximately one-third of such patients have a disseminated disease at the time of diagnosis.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> The identification of nocardial infection is clinically challenging because it is often indistinguishable from other infections and malignancy. Although FDG uptake in cerebral and pulmonary nocardia infection were presented before, disseminated nocardiosis mimicking malignancy has not been reported yet.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> Nocardiosis should be kept in mind while reporting FDG PET/CT studies of immunocompromised patients since it may produce lesions suggestive for malignancy. Additionally, biopsy should be recommended for suspicious lesions. FDG PET/CT may have a role in defining the biopsy location as this was the case in our patient.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0010" class="elsevierStylePara elsevierViewall">All the authors state that there were no conflicts of interests when the manuscript was written.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 985 "Ancho" => 1950 "Tamanyo" => 215159 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">FDG PET/CT images showed intense hypermetabolic mass lesion in the right upper lobe (3.5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm) (SUVmax: 12.0) (A: Maximum intensity projection (MIP) image, B: axial PET, CT and fusion PET/CT images), multiple moderate-intense hypermetabolic parenchymal nodules in both lungs (SUVmax: 6.5) (A, C) and moderate-intense hypermetabolic multiple soft-tissue lesions (SUVmax: 10.7) in the right teres minor, bilateral gluteus medius, right erector spinae, left trapezius, right quadriceps femoris, right adductor magnus, left adductor longus muscles and subcutaneous tissue (A, D).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Elevated uptake of <span class="elsevierStyleSup">18</span>F-FDG in PET/CT imaging of a nocardial pleural nodule" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Zhao" 1 => "M.J. Dong" 2 => "Z.K. Sheng" 3 => "K.F. Liu" 4 => "S.Y. Yang" 5 => "Z.F. Liu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clinimag.2011.09.007" "Revista" => array:6 [ "tituloSerie" => "Clin Imaging" "fecha" => "2012" "volumen" => "36" "paginaInicial" => "383" "paginaFinal" => "385" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22726980" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disseminated nocardiosis in a patient with nephrotic syndrome following HIV infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Zhou" 1 => "H. Lıu" 2 => "F. Yuan" 3 => "S. Yuan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3892/etm.2014.1883" "Revista" => array:6 [ "tituloSerie" => "Exp Ther Med" "fecha" => "2014" "volumen" => "8" "paginaInicial" => "1142" "paginaFinal" => "1144" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25187812" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "PET imaging of cerebral and pulmonary Nocardia infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N.B. Mascarenhas" 1 => "D. Lam" 2 => "G.R. Lynch" 3 => "R.E. Fisher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.rlu.0000200597.42832.39" "Revista" => array:6 [ "tituloSerie" => "Clin Nucl Med" "fecha" => "2006" "volumen" => "31" "paginaInicial" => "131" "paginaFinal" => "133" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16495729" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/2253654X/0000003400000004/v1_201506220006/S2253654X14002170/v1_201506220006/en/main.assets" "Apartado" => array:4 [ "identificador" => "7907" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Imágenes de interés" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/2253654X/0000003400000004/v1_201506220006/S2253654X14002170/v1_201506220006/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X14002170?idApp=UINPBA00004N" ]
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