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Erschienen in:
06.07.2021 | Images that Teach
The value of 18F-FDG PET/CT in two cases of Primary Pericardial Mesothelioma
Erschienen in: Journal of Nuclear Cardiology | Ausgabe 6/2022
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The first case is a 77-year-old woman who underwent breast cancer surgery 30 years ago. Clinically, the patient presented dyspnea secondary to pericardial effusion. During the assessment process, pericardial fluid cytology was performed, identifying atypical epithelial cells. PET/CT was requested to evaluate the origin of the primary tumor (Figure 1).
Figure 1
18F-FDG PET / CT after injection of 7.75 mCi / 286.75 Mbq. (A, C, D, E) FDG PET axial, coronal and MIP images showed multiple hypermetabolic foci which corresponded to an intense nodular pericardial uptake (SUVmax 9.21). In addition, the axial image (A) demonstrated pleural effusion without significant metabolic uptake. (B) CT images showed the heterogeneous pericardial thickening. In this case, the pericardial fluid cytology showed atypical epithelial cells and the suspicion that it had, which was metastatic spread; however PET/CT did not identify other hypermetabolic area suggestive of another primary tumor. The high pericardial hyaluronic acid complicated the correct cytological examination and the definitive histological diagnosis is often obtained after autopsy or surgery, like in this case it required surgical biopsy. Immunochemistry after pericardium biopsy was performed for CKAE1/AE3, Vimentin, focal calretinin, WT1, CK7, and CK5/6 being diagnosed of pericardial mesothelioma
Figure 2
A 39-year-old patient with double-lung transplant comparing the initial electrocardiogram (ECG) (Image 1) to the ECG at the emergency services (Image 2). Image 1. Normal sinus rhythm at 80 beats per minute (bpm), PR normal and normal axis. Elevated precordial voltages: huge precordial R and S waves, respectively, and alteration of repolarization in the inferior and lateral face. Image 2. Sinus tachycardia at 110 bpm with normal PR and normal axis. High voltages at precordial leads persist secondary to ventricular hypertrophy, and also in aVL and aVF leads the repolarization alterations persist. The patient reported fever, dyspnea, and syncope. Thorax X-ray in the emergency room dismisses pneumonic focus. In the blood test, he presented renal failure with creatinine 3mg/dl, proBNP >500pg/ml, and CRP 175mg/dl, so he was hospitalized
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