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Incidental Acute Appendicitis on Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) Imaging: Radiology From a Different Perspective

Although Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) is routinely used in oncological imaging, the F-18 fluorodeoxyglucose (18F-FDG) avidity is not tumor-specific. Numerous benign infective and inflammatory processes may also show increased radiot...

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Autores principales: Hamid, Samar, Nausheen, Sadaf, Ahmed, Naveed, Hussain, Riffat P, Ihsan, Nida
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8491630/
https://www.ncbi.nlm.nih.gov/pubmed/34659948
http://dx.doi.org/10.7759/cureus.17734
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author Hamid, Samar
Nausheen, Sadaf
Ahmed, Naveed
Hussain, Riffat P
Ihsan, Nida
author_facet Hamid, Samar
Nausheen, Sadaf
Ahmed, Naveed
Hussain, Riffat P
Ihsan, Nida
author_sort Hamid, Samar
collection PubMed
description Although Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) is routinely used in oncological imaging, the F-18 fluorodeoxyglucose (18F-FDG) avidity is not tumor-specific. Numerous benign infective and inflammatory processes may also show increased radiotracer activity. Similarly, abnormal 18F-FDG uptake in an inflamed appendix can pose a diagnostic challenge for the interpreter of oncologic 18F-FDG PET/CT. We present the case of an 18-year-old female with classic Hodgkin's lymphoma who had 18F-FDG PET/CT while undergoing chemoradiotherapy. The scan demonstrated a complete metabolic response to treatment. However, there was increased 18F-FDG uptake in the right iliac region, projecting over the appendix, which, if interpreted as a lymphomatous involvement, would have upscaled the treatment response to progressive disease. The patient was called for additional workup, which included an ultrasound abdomen. The scan revealed classic features of acute appendicitis. However, there was no appendicolith or luminal obstruction. Upon additional questioning, the patient mentioned mild intermittent abdominal pain and anorexia eased by pain relievers for the preceding few days. On deep palpation of her abdomen, there was rebound tenderness in the right iliac region. According to the Alvarado score, it was graded 7 points suggesting probable/likely appendicitis. After collective evaluation of the clinical, laboratory, and imaging findings, the appendicular 18F-FDG uptake was deemed secondary to uncomplicated acute appendicitis rather than a lymphomatous lesion. Our patient refused surgery as she did not have severe abdominal pain. She was hemodynamically stable without signs of luminal obstruction. She was non-operatively managed with broad-spectrum antibiotics for six days. The results of the follow-up complete blood counts and ultrasound examination were negative. Our patient was symptom-free and recovering normally at a two-week follow-up appointment. We present a follow-up case of classic Hodgkin's lymphoma with incidental uptake in the appendix, which resembled submucosal lymphomatous cell infiltration of the appendix. Careful scrutiny, clinical correlation, physical examination, blood tests, and additional imaging offered helpful insight and led to the correct, benign diagnosis of the 18F-FDG avid appendix.
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spelling pubmed-84916302021-10-14 Incidental Acute Appendicitis on Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) Imaging: Radiology From a Different Perspective Hamid, Samar Nausheen, Sadaf Ahmed, Naveed Hussain, Riffat P Ihsan, Nida Cureus Radiology Although Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) is routinely used in oncological imaging, the F-18 fluorodeoxyglucose (18F-FDG) avidity is not tumor-specific. Numerous benign infective and inflammatory processes may also show increased radiotracer activity. Similarly, abnormal 18F-FDG uptake in an inflamed appendix can pose a diagnostic challenge for the interpreter of oncologic 18F-FDG PET/CT. We present the case of an 18-year-old female with classic Hodgkin's lymphoma who had 18F-FDG PET/CT while undergoing chemoradiotherapy. The scan demonstrated a complete metabolic response to treatment. However, there was increased 18F-FDG uptake in the right iliac region, projecting over the appendix, which, if interpreted as a lymphomatous involvement, would have upscaled the treatment response to progressive disease. The patient was called for additional workup, which included an ultrasound abdomen. The scan revealed classic features of acute appendicitis. However, there was no appendicolith or luminal obstruction. Upon additional questioning, the patient mentioned mild intermittent abdominal pain and anorexia eased by pain relievers for the preceding few days. On deep palpation of her abdomen, there was rebound tenderness in the right iliac region. According to the Alvarado score, it was graded 7 points suggesting probable/likely appendicitis. After collective evaluation of the clinical, laboratory, and imaging findings, the appendicular 18F-FDG uptake was deemed secondary to uncomplicated acute appendicitis rather than a lymphomatous lesion. Our patient refused surgery as she did not have severe abdominal pain. She was hemodynamically stable without signs of luminal obstruction. She was non-operatively managed with broad-spectrum antibiotics for six days. The results of the follow-up complete blood counts and ultrasound examination were negative. Our patient was symptom-free and recovering normally at a two-week follow-up appointment. We present a follow-up case of classic Hodgkin's lymphoma with incidental uptake in the appendix, which resembled submucosal lymphomatous cell infiltration of the appendix. Careful scrutiny, clinical correlation, physical examination, blood tests, and additional imaging offered helpful insight and led to the correct, benign diagnosis of the 18F-FDG avid appendix. Cureus 2021-09-05 /pmc/articles/PMC8491630/ /pubmed/34659948 http://dx.doi.org/10.7759/cureus.17734 Text en Copyright © 2021, Hamid et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Radiology
Hamid, Samar
Nausheen, Sadaf
Ahmed, Naveed
Hussain, Riffat P
Ihsan, Nida
Incidental Acute Appendicitis on Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) Imaging: Radiology From a Different Perspective
title Incidental Acute Appendicitis on Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) Imaging: Radiology From a Different Perspective
title_full Incidental Acute Appendicitis on Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) Imaging: Radiology From a Different Perspective
title_fullStr Incidental Acute Appendicitis on Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) Imaging: Radiology From a Different Perspective
title_full_unstemmed Incidental Acute Appendicitis on Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) Imaging: Radiology From a Different Perspective
title_short Incidental Acute Appendicitis on Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) Imaging: Radiology From a Different Perspective
title_sort incidental acute appendicitis on fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18f-fdg pet/ct) imaging: radiology from a different perspective
topic Radiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8491630/
https://www.ncbi.nlm.nih.gov/pubmed/34659948
http://dx.doi.org/10.7759/cureus.17734
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