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Case Reports
. 2020 Winter;8(1):74-78.
doi: 10.22038/aojnmb.2019.38132.1255.

Pericardial sarcoidosis presenting as PUO diagnosed on FDG PET CT scan

Solav Shrikant Vasantrao  1 , Patil Abhijit Mahaveer  1 , Savale Shailendra Vasant  1 , Salunke Deepak Vishnu  2
Affiliations
Case Reports

Pericardial sarcoidosis presenting as PUO diagnosed on FDG PET CT scan

Solav Shrikant Vasantrao et al. Asia Ocean J Nucl Med Biol. 2020 Winter.

Abstract

Pyrexia of unknown origin (PUO) is a common problem in day-to-day practice. FDG PET CT is an established investigation that aids in identifying the cause of PUO. Due to its high sensitivity PET detects an occult hypermetabolic focus in the body where CT helps in anatomical localization, vascularity, enhancement characteristics of the lesion detected on PET. It helps to differentiate benign versus malignant cause and target biopsy. Tuberculosis, lymphoma, pyelonephritis, thyroiditis appear hypermetabolic on FDG PET CT. Pericardial sarcoidosis is rare and not reported in literature as a cause of PUO. Presented here is a case of PUO secondary to pericardial granulomatosis diagnosed on PET CT. Cardiac MRI also helps in better tissue characterization and associated myocardial involvement of sarcoidosis. Histology confirmed the diagnosis of pericardial sarcoidosis in this case.

Keywords: FDG PET CT; PUO; Pericardial; Sarcoidosis.

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Figures

Figure1
Figure1
a) 3D MIP of whole body PET CT, b,d) Axial CT and c,e) hypermetabolic right supraclavicular and mediastinal (right paratracheal, pretracheal and left prevascular) nodes
Figure 2
Figure 2
a,c,) Plain CT b,d,) PET CT images reveal hypermetabolic pericardial wall thickening and bilateral pleural effusion. e) Two chamber short and f) long axis T2TSE MRI and g,h) corresponding sequential fusion PET MRI reveal pericardial thickening appearing heterogeneously hyperintense on T2 WI corresponding to the hypermetabolic pericardial thickening on PET CT
Figure 3
Figure 3
Microphotograph showing noncaseating epithelioid granuloma with multinucleate Langhans giant cell in different magnifications. There are areas of necrosis and surrounding lymphocytic infiltrate with sclerosis consistent with sarcoidosis
See this image and copyright information in PMC

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