Pulmonary tumor embolus with high 18FDG uptake mimicking lung metastasis from renal-cell cancer

Leuzzi, Giovanni; Melis, Enrico; Forcella, Daniele; Facciolo, Francesco

doi:10.1016/j.remnie.2015.07.010

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The clinical diagnosis was consistent with intrapulmonary lymph-node associated to tuberculosis. (B) CT scan performed 18 years after: CT slice demonstrates the enlargement of the lung nodule (26mm in the major axis). (C) Whole body PET/CT performed 1h after the administration of 296MBq of 18FDG (axial, coronal and sagittal slices): the images evidenced an increased uptake of a round-shaped solid nodule of the right lower lobe (SUV max 4.7). No sign of mediastinal or extra-thoracic disease was disclosed." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Giovanni Leuzzi, Daniele Forcella, Enrico Melis, Paolo Visca, Francesco Facciolo" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Giovanni" "apellidos" => "Leuzzi" ] 1 => array:2 [ "nombre" => "Daniele" "apellidos" => "Forcella" ] 2 => array:2 [ "nombre" => "Enrico" "apellidos" => "Melis" ] 3 => array:2 [ "nombre" => "Paolo" "apellidos" => "Visca" ] 4 => array:2 [ "nombre" => "Francesco" "apellidos" => "Facciolo" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808915000853?idApp=UINPBA00004N" "url" => "/22538089/0000003400000005/v1_201508130058/S2253808915000853/v1_201508130058/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2253808915000750" "issn" => "22538089" "doi" => "10.1016/j.remnie.2015.07.001" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "684" "copyright" => "Elsevier España, S.L.U. and SEMNIM" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Esp Med Nucl Imagen Mol. 2015;34:321-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 204 "formatos" => array:2 [ "HTML" => 39 "PDF" => 165 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Clinical note" "titulo" => "111In-octreotide SPECT–CT in head and neck paragangliomas" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "321" "paginaFinal" => "324" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "SPECT-TC con 111In-octreotide en paragangliomas de cabeza y cuello" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 857 "Ancho" => 2500 "Tamanyo" => 108767 ] ] "descripcion" => array:1 [ "en" => "Clinical case 2. Resected paraganglioma in left mastoid lesion. (A) SPECT with 111In-octreotide showing left nodular lesion with high expression of SSR; (B) MR: lesion in the anterior wall of the tympanic cavity which does not differentiate between residual tissue, recurrence or scar tissue; (C) fused images of SPECT-MR. Characterization of persistent post-surgical tumour tissue." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Castillo-Berrio, M. Castrillón, F. Zelaya, D. Ruíz, F. Loira, J.M. Nogueiras, A. López, R. Guitián, J. Outomuro, A. Serena, L.M. Campos" "autores" => array:11 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Castillo-Berrio" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Castrillón" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Zelaya" ] 3 => array:2 [ "nombre" => "D." "apellidos" => "Ruíz" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "Loira" ] 5 => array:2 [ "nombre" => "J.M." "apellidos" => "Nogueiras" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "López" ] 7 => array:2 [ "nombre" => "R." "apellidos" => "Guitián" ] 8 => array:2 [ "nombre" => "J." "apellidos" => "Outomuro" ] 9 => array:2 [ "nombre" => "A." "apellidos" => "Serena" ] 10 => array:2 [ "nombre" => "L.M." "apellidos" => "Campos" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X1500027X" "doi" => "10.1016/j.remn.2015.02.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X1500027X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808915000750?idApp=UINPBA00004N" "url" => "/22538089/0000003400000005/v1_201508130058/S2253808915000750/v1_201508130058/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "Interesting image" "titulo" => "Pulmonary tumor embolus with high 18FDG uptake mimicking lung metastasis from renal-cell cancer" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "325" "paginaFinal" => "326" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Giovanni Leuzzi, Enrico Melis, Daniele Forcella, Francesco Facciolo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Giovanni" "apellidos" => "Leuzzi" "email" => array:1 [ 0 => "gio.leuzzi@yahoo.it" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Enrico" "apellidos" => "Melis" ] 2 => array:2 [ "nombre" => "Daniele" "apellidos" => "Forcella" ] 3 => array:2 [ "nombre" => "Francesco" "apellidos" => "Facciolo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute, IFO, Rome, Italy" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Embolia pulmonar tumoral con alta captación de 18FDG imitando metástasis pulmonar de cáncer de células renales" ] ] "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" => 1246 "Ancho" => 1660 "Tamanyo" => 490579 ] ] "descripcion" => array:1 [ "en" => "Intraoperative findings: after arteriotomy of the lower pulmonary artery, an attempt to remove the thrombus was performed. Due to macroscopic infiltration of the arterial posterior wall, a left lower lobectomy was carried out in order to obtain a radical resection. Final pathology was consistent with tumor embolus from RCC." ] ] ] "textoCompleto" => "A 60-year-old Caucasian man referred to our Department for chest pain and dry cough from 15 days. His medical history was unremarkable with the exception of renal-cell cancer (RCC) diagnosed and resected six months earlier by a right radical nephrectomy. Few days before the admission, a whole body 18FDG positron emission tomography (PET-CT) scan was performed: nuclear images evidenced a left hilar hyper-metabolism (SUV max 6.7) suggestive of intrapulmonary recurrence (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A–C). After the admission, due to symptoms aggravation, a contrast-enhanced computed tomography (CT) scan was carried out disclosing a hyper-vascularized solid nodule (measuring 19mm in the major axis) localized into the left inferior pulmonary artery and with extension through the lingular artery (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D), consistent with tumor embolus. After a multidisciplinary meeting, the patient underwent surgery in order to obtain immediate arterial desobstruction. Intra-operatively, an infiltration of the vascular posterior wall was disclosed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) so the patient underwent a left lower lobectomy for radical intent without complication. Final pathology was consistent with RCC embolus. No evidence of recurrence was found at 1 year of follow-up.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>In literature, thrombosis in cancer patients is usually reported, while tumor thrombosis is very uncommon. As a rule, such complication may develop in patients with tumors arising from liver, pancreas, kidney and colon as a result of direct infiltration of vena cava or other major vessels.<a class="elsevierStyleCrossRef" href="#bib0020">1</a>In this setting, discrimination between regular and tumor thrombus is a challenging clinical issue in RCC patients<a class="elsevierStyleCrossRef" href="#bib0025">2</a> because of the different treatments proposed (antithrombotic therapy vs endovascular/surgical removal). PET-CT has been evaluated by others in the assessment of embolism, however, due to low sensitivity rate reported, its utility for metastases identification is still controversial in RCC.<a class="elsevierStyleCrossRef" href="#bib0030">3</a>According to these findings and to the case we presented, we believe that contrast-enhanced CT scan may be more sensitive in diagnosing lung tumor embolism. When this condition is suspected, radiological (CT-scan) and nuclear (PET-CT) imaging should be jointly employed in order to obtain a more accurate evaluation in RCC patients and to distinguish between benign or malignant thrombus and lung metastases. Furthermore, a thromboarteriectomy (and pulmonary resection if vascular infiltration is evidenced) is mandatory to perform oncological and vascular treatment simultaneously.Conflict of interestNone declared." "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 "fechaRecibido" => "2014-11-21" "fechaAceptado" => "2014-12-16" "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3051 "Ancho" => 1658 "Tamanyo" => 437233 ] ] "descripcion" => array:1 [ "en" => "(A–C) Whole body PET-CT performed 1h after the administration of 296MBq of 18FDG: the images evidenced an increased uptake of a round-shaped solid nodule localized in the left pulmonary hilum (SUV max 6.7). No sign of mediastinal or extra-thoracic disease was disclosed. (D) Contrast-enhanced CT scan performed after patient's admission: CT slice showed a hyper-vascularized solid nodule (measuring 19mm in the major axis) localized into the left inferior pulmonary artery and with extension through the lingular artery. Based on nuclear and radiological imaging, a diagnosis of tumor thrombus was achieved." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1246 "Ancho" => 1660 "Tamanyo" => 490579 ] ] "descripcion" => array:1 [ "en" => "Intraoperative findings: after arteriotomy of the lower pulmonary artery, an attempt to remove the thrombus was performed. Due to macroscopic infiltration of the arterial posterior wall, a left lower lobectomy was carried out in order to obtain a radical resection. Final pathology was consistent with tumor embolus from RCC." ] ] ] "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" => "Malignancies, prothrombotic mutations, and the risk of venous thrombosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.W. Blom" 1 => "C.J. Doggen" 2 => "S. Osanto" 3 => "F.R. Rosendaal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.293.6.715" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2005" "volumen" => "293" "paginaInicial" => "715" "paginaFinal" => "722" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15701913" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Positron emission tomography-computed tomography imaging characteristics of an inferior vena cava tumor thrombus with magnetic resonance imaging correlation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.N. Rydberg" 1 => "G.S. Sudakoff" 2 => "R.S. Hellman" 3 => "W.A. See" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Comput Assist Tomogr" "fecha" => "2004" "volumen" => "28" "paginaInicial" => "517" "paginaFinal" => "519" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15232383" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Positron emission tomography enhancing tumor thrombus in patient with renal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Snow" 1 => "D. Cohen" 2 => "W.C. Chapman" 3 => "R.L. Grubb 3rd" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.urology.2008.08.463" "Revista" => array:6 [ "tituloSerie" => "Urology" "fecha" => "2009" "volumen" => "73" "paginaInicial" => "270" "paginaFinal" => "271" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18950838" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000003400000005/v1_201508130058/S2253808915000841/v1_201508130058/en/main.assets" "Apartado" => array:4 [ "identificador" => "7927" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Interesting images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22538089/0000003400000005/v1_201508130058/S2253808915000841/v1_201508130058/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808915000841?idApp=UINPBA00004N"]

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The Revista Española de Medicina Nuclear e Imagen Molecular (Spanish Journal of Nuclear Medicine and Molecular Imaging), was founded in 1982, and is the official journal of the Spanish Society of Nuclear Medicine and Molecular Imaging, which has more than 700 members. The Journal, which publishes 6 regular issues per year, has the promotion of research and continuing education in all fields of Nuclear Medicine as its main aim. For this, its principal sections are Originals, Clinical Notes, Images of Interest, and Special Collaboration articles. The works may be submitted in Spanish or English and are subjected to a peer review process. In 2009, it became the leading Spanish journal in the field of Medical Imaging on having an Impact Factor , awarded by the Journal Citation Reports.

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Vol. 34. Issue 5.

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