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Incidental finding of epiploic appendagitis in the 18F-FDG PET/CT study of a patient with recurrence of ovarian cancer
Hallazgo incidental de apendagitis epiploica en estudio 18F-FDG PET/TC de paciente con recidiva de Cáncer de ovario
P. Guardia Jimenaa,b,
, M.V. Guiote Morenob,c, A.M. Santos Buenoa,b, J.A. Vallejo Casasb,c
Corresponding author
a Unidad de Gestión Clínica de Medicina Nuclear, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
b Unidad de Gestión Clínica de Medicina Nuclear, Hospital Universitario Reina Sofía, Córdoba, Spain
c Instituto Maimónides de Investigación Biomédica (IMIBIC), Universidad de Córdoba, Córdoba, Spain
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Inicia tratamiento quimioterápico adyuvante, presentando respuesta completa y tras 2 años recidiva con adenopatías patológicas mediastínicas, mesentéricas y pélvicas por lo que comienza un nuevo tratamiento quimioterápico con buena respuesta. En PET/TC realizado para caracterizar un nódulo pulmonar en TC de seguimiento se evidencia como único hallazgo una lesión con hipermetabolismo en anillo y trabeculación de la grasa perilesional sugestiva de apendagitis epiploica. Estudio PET/TC adquirido a los 60<span class="elsevierStyleHsp" style=""></span>min de la administración intravenosa de 222<span class="elsevierStyleHsp" style=""></span>MBq de <span class="elsevierStyleSup">18</span>FFDG. a y b) Proyección de máxima intensidad (MIP) coronal, se observa lesión hipermetabólica supravesical (flecha azul). c-e) plano axial y sagital PET/TC que muestra una lesión grasa ovoidea de 2,3<span class="elsevierStyleHsp" style=""></span>cm adyacente a sigma con hipermetabolismo en anillo (SUVmáx 7,2) y trabeculación de la grasa perilesional. f) Plano axial de TC de control realizado 2 meses después en el que ya no se evidenciaba la lesión que había respondido al tratamiento antiinflamatorio.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Guardia Jimena, M.V. Guiote Moreno, A.M. Santos Bueno, J.A. Vallejo Casas" "autores" => array:4 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Guardia Jimena" ] 1 => array:2 [ "nombre" => "M.V." 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B) Coronal PET/CT fusion images showing a right parapharyngeal submucosa hypermetabolic soft tissue mass (SUVmax: 7.6) obliterating the airway and collapsing the piriform sinus in relation to abscess. C) Fusion image in axial section showing hypermetabolic collection (SUVmax: 8.1) invading the visceral space and contacting the anterior border of the thyroid gland and cartilage, surpassing the midline. D) Sagittal fusion section showing an extensive descending restroesophageal-prevertebral mediastinal collection with hypermetabolic peripheral enhancement without affecting the vertebral bodies. E) Axial section showing left pleural effusion and hyperenhancement of the pleural layers in relation to empyema.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Valverde-Jorge, I. Fernández-Tercero, M. Jiménez-Jiménez, M. Jauregui-García, J. Genollá-Subirats, E. Rodeño-Ortiz de Zárate" "autores" => array:6 [ 0 => array:2 [ "nombre" => "R." 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(A) D7, L2 and S1. (B) Right frontoparietal subcutaneous mass, D12 and in the cauda equina at the level of S1-S4.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Guzmán Ortiz, R. Jimeno Pernett, M. Mitjavila Casanovas" "autores" => array:3 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Guzmán Ortiz" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Jimeno Pernett" ] 2 => array:2 [ "nombre" => "M." 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"apellidos" => "Santos Bueno" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J.A." "apellidos" => "Vallejo Casas" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Medicina Nuclear, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Medicina Nuclear, Hospital Universitario Reina Sofía, Córdoba, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Instituto Maimónides de Investigación Biomédica (IMIBIC), Universidad de Córdoba, Córdoba, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hallazgo incidental de apendagitis epiploica en estudio <span class="elsevierStyleSup">18</span>F-FDG PET/TC de paciente con recidiva de Cáncer de ovario" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 731 "Ancho" => 2007 "Tamanyo" => 160928 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A 62-year-old woman underwent surgery for a diagnosis of bilateral mixed malignant ovarian tumor, accompanied by reactive lymphadenitis and metastatic involvement of the omentum and ileocecal appendix. She started adjuvant chemotherapy treatment presenting complete response and after two years relapsed with pathological mediastinal, mesenteric and pelvic lymphadenopathies, for which she started a new chemotherapy treatment with good response. On the PET/CT scan performed to characterize a pulmonary nodule seen in a follow-up CT scan, the only finding was a lesion with ring-shaped hypermetabolism and trabeculation of the perilesional fat suggestive of epiploic appendagitis. PET/CT study acquired 60 min after the intravenous administration of 222 MBq of <span class="elsevierStyleSup">18</span>FFDG. (a and b) Maximum intensity projection (MIP) coronal, supravesical hypermetabolic lesion is observed (blue arrow). (C–e) axial and sagittal PET/CT showing a 2.3 cm ovoid fatty lesion adjacent to the sigma with ring-shaped hypermetabolism (SUVmax 7.2) and trabeculation of the perilesional fat. f) Axial plane of control CT carried out two months later showing no evidence of the lesion that had responded to anti-inflammatory treatment.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Acute epiploic appendagitis is a self-limited inflammation caused by torsion of the epiploic appendages, occluding blood circulation and causing ischemia. It occurs more frequently in the sigmoid and descending colon, is predominant in men between the fourth and fifth decades of life and is related to obesity. It is a rare entity and its incidence is unclear, because it presents symptoms based on abdominal pain rarely associated with nausea, fever and leukocytosis; which is confused with acute inflammatory diseases such as appendicitis, cholecystitis and diverticulitis. Diagnosis is mainly made by CT scan showing the typical radiological signs of an ovoid mass with hyperdense ring between 1.5 and 3.5 cm with parietal thickening of the peritoneum.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> The PET/CT study shows increased FDG uptake, so a differential diagnosis must be made with other entities such as omental infarction and primary tumors or mesenteric metastases; as well as other causes of fat necrosis such as pancreatitis or trauma.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Treatment is conservative with oral anti-inflammatory drugs and the symptoms resolve in 1 or 2 weeks, although the radiological lesion may persist after 6 months.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We show the PET/CT study of a patient with ovarian cancer with epiploic appendagitis that allowed us to rule out metastatic progression and continue with chemotherapy treatment (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 731 "Ancho" => 2007 "Tamanyo" => 160928 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A 62-year-old woman underwent surgery for a diagnosis of bilateral mixed malignant ovarian tumor, accompanied by reactive lymphadenitis and metastatic involvement of the omentum and ileocecal appendix. She started adjuvant chemotherapy treatment presenting complete response and after two years relapsed with pathological mediastinal, mesenteric and pelvic lymphadenopathies, for which she started a new chemotherapy treatment with good response. On the PET/CT scan performed to characterize a pulmonary nodule seen in a follow-up CT scan, the only finding was a lesion with ring-shaped hypermetabolism and trabeculation of the perilesional fat suggestive of epiploic appendagitis. PET/CT study acquired 60 min after the intravenous administration of 222 MBq of <span class="elsevierStyleSup">18</span>FFDG. (a and b) Maximum intensity projection (MIP) coronal, supravesical hypermetabolic lesion is observed (blue arrow). (C–e) axial and sagittal PET/CT showing a 2.3 cm ovoid fatty lesion adjacent to the sigma with ring-shaped hypermetabolism (SUVmax 7.2) and trabeculation of the perilesional fat. f) Axial plane of control CT carried out two months later showing no evidence of the lesion that had responded to anti-inflammatory treatment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epiploic appendagitis: pathogenesis, clinical findings and imaging clues of a misdiagnosed mimicker" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Giannis" 1 => "E. Matenoglou" 2 => "M.S. Sidiropoulou" 3 => "A. Papalampros" 4 => "R. Schmitz" 5 => "E. 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