Severe Pulmonary Emphysema with Secondary Pulmonary Hypertension: 18F-FDG PET Abnormalities Ching-Yuan Chen1, Wei-Jen Shih2, Wen-Sheng Huang1, Hong-Ming Zhuang3, Primo Milan4, Daniel Hong-Yuan Shen1, Yu-Ming Fan1, Shiou-Chi Cherng1 1
Department of Nuclear Medicine, Tri-Service General Hospital, Taipei, Taiwan, Nuclear Medicine Service, Veterans Administration Medical Center; Department of Diagnostic Radiology, College of Medicine, University of Kentucky, Lexington, KY, USA 3 Division of Nuclear Medicine, Department of Radiology, University of Pennsylvania Hospital, Philadelphia, PA, USA 4 Department of Diagnostic Radiology, College of Medicine, University of Kentucky, Lexington, KY, USA 2
A 60-year-old male presented with a solitary pulmonary
detection of unexpected cardiac abnormalities by FDG-
nodule (SPN) in the right upper lobe by computed
PET in patient evaluated for SPN.
18
tomography (CT) of the chest. He was referred for Ffluorodeoxyglucose positron emission tomography
Key words: solitary pulmonary nodule (SPN), 18F-fluo-
(FDG-PET) to evaluate the nature of the nodule. FDG-
rodeoxyglucose positron emission tomography (FDG-
PET images showed downward displacement of both
PET), emphysematous changes of both lungs, enlarge-
diaphragms with flattened upper boarder of the liver,
ment of both ventricles
elongated vertical dimension of the thoracic cavity, and increased radioactivity in the region of the stomach,
Ann Nucl Med Sci 2005;18:121-125
while there was no definite lesion with increased FDG metabolism in the lungs. In addition, the following cardiac chamber abnormalities were found: thickened
18
F-fluorodeoxyglucose positron emission tomography
inter-ventricular septum, well visualization of the right
(FDG-PET) has been used to measure the increased glucose
and left ventricles - thicken free walls of the left and
metabolism in tumor cells [1], which has a high rate of glu-
right ventricles. Follow-up chest radiography showed
cose consumption under both aerobic and anaerobic condi-
downward displacement of both diaphragms with elon-
tions. The FDG-PET has reached widespread application in
gation of vertical dimension of both lungs, consistent
the assessment of solitary pulmonary nodule (SPN) [2]. The
with emphysematous changes. CT of the chest with
goal of FDG metabolic evaluation of a SPN is to distinguish
lung window demonstrated emphysematous changes of
between benign and malignant disease [2]. Most of SPNs are
both lungs, consistent with pulmonary emphysema and
benign, only one-three is malignant lung cancer. Currently
enlargement of both ventricles, corresponding to sec-
plain radiography and computed tomography (CT) are most
ondary pulmonary hypertension with ventricular abnor-
commonly used modalities [3]. However, most noncalcified
malities. In summary, we discovered that incidental
SPNs may remain indeterminate on the basis of results at plain radiography and CT. The authors present that incidental detection of unexpected cardiac abnormalities by FDG-PET
Received 12/6/2004; revised 3/3/2005; accepted 3/5/2005. For correspondence or reprints contact: Shiou-Chi Cherng, M.D., Department of Nuclear Medicine, Tri-Service General Hospital, 325 Section 2, Cheng-Kung Road, Nei-Hu, Taipei 114, Taiwan, ROC. Tel: (886)2-87927374, Fax: (886)287927217, E-mail:
[email protected]
in patient evaluated for SPN.
ౘᇉ̮ ඈ Chen CY et al
Case Report A 60-year-old male smoker presented with a long-term history of dry cough. CT of the chest disclosed a SPN in the right upper lobe (Figure 1). He was referred for FDG-PET to evaluate the nature of the nodule. Nuclear Medicine and Related Studies Coronal section of PET images showed downward dis-
Figure 3. Follow-up chest radiography shows downward displacement of both diaphragms with elongation of vertical dimension of both lungs, consistent with emphysematous changes. Figure 1. A CT image shows a nodule in the right upper lobe (arrow) of the lungs.
placement of both diaphragms with flattened upper boarder of the liver, elongated vertical dimension of the thoracic cavity, and increased radioactivity in the region of the stomach, while there was no definite lesion with increased FDG metabolism in the lungs. In addition, the following cardiac chamber abnormalities were found: thickened inter-ventricular septum, well visualization of the right and left ventricles?thicken free walls of the left and right ventricles (Figure 2). Follow-up chest radiography showed downward displacement of both diaphragms with elongation of vertical dimension of both lungs, consistent with emphysematous changes (Figure 3). CT of the chest with lung window demonstrated emphysematous changes of both lungs and enlargement of both ventricles (Figure 4). Diagnosis
Figure 2. Coronal section of 18F-FDG PET images show downward displacement of both hemi-diaphragms with flattened upper boarder of the liver, elongated vertical dimension of the thoracic cavity, and increased radioactivity in the region of the stomach (arrowhead). In addition, thickened inter-ventricular septum and well visualization of the right and left ventricles-thicken free walls of the left and right ventricles are noted.
Ann Nucl Med Sci 2004;18:121-125
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1. Severe Pulmonary Emphysema with secondary pulmonary hypertension 2. Enlargement of both ventricles
Discussion Increased FDG uptake in the right cardiac chambers in
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۱ঈཚ̝ϒ̄ౄᇆ PET of pulmonary emphysema
Figure 4. CT of the chest with lung window (left) shows emphysematous changes of both lungs and enlargement of both ventricles; mediastinal window (right) also shows enlargement of both ventricles. R: right ventricle, L: left ventricle.
a patient with pulmonary emphysema has been reported [3-
2. Fischer BM, Mortensen J, Dirksen A, et al. Positron
5]. However, our patient is different in describing symmetri-
emission tomography of incidentally detected small pul-
cal downward displacement of both diaphragms, elongated
monary nodules. Nucl Med Comm 2004;25:3-6.
vertical dimension of the thoracic cavity, and increased FDG
3. Gupta NC, Frank AR, Dewan NA, et al. Solitary pul-
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441-444.
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4. Duarte PS, Zhuang H, Machado C, Aldighieri F, Martins
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LR, Alonso G. Increased FDG uptake in the right cardiac
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has been demonstrated that incidental detection of an unex-
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6. Otani H, Kagaya Y, Yamane Y, et al. Long-term right
diomyopathy or pulmonary hypertension, may be also noted,
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[email protected]
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