History
77-year-old female who has a history of ulcerative colitis status post colectomy, Koch pouch, and cholecystectomy. Her recent CT demonstrated significant dilatation involv- ing the biliary ducts and colon. Evaluation for malignancy is requested.
Findings
There are multiple sites of hypermetabolism involving the glenohumeral joints (Figures 14.1.1, 14.1.2A, and 14.1.2B), right sternoclavicular joint (Figure 14.1.3), and humeri bilaterally. The sternoclavicular joints, more on the right, are also involved. The tracer localization to the metacarpal-carpal bones, more on the right, is also noted.
Uptake in the hips, more prominent on the left, is noted. These findings are consistent with inflammatory joint disease. There is right renal stasis with evidence of caliectasis (Figure 14.1.4). The superficial lower right abdominal uptake is compatible with Koch’s pouch (Figure 14.1.5). The activity at the base of the neck bilaterally is muscular uptake and is considered physiologic.
Impression
1. Multifocal inflammatory joint disease.
2. Koch’s pouch.
14 Inflammatory Disease and Infection
Lalitha Ramanna
Case 14.1
152
FIGURE14.1.1.
FIGURE14.1.2A. FIGURE14.1.2B.
FIGURE14.1.3. FIGURE14.1.4.
Pearls and Pitfalls
• Patients with bone prostheses may present with a false-positive PET study for infec- tion since a loosening may be associated with elevated uptake. FDG uptake specifi- cally in the synovial joint is considered synovitis.1,2,3
• 50% of the joint accumulations are seen in the acromio-clavicular joint, 80% in the glenohumeral joint, 50% in the hip joint, 90% in the knee joint, and 80% in the talotibial joints.3
• FDG accumulations in the joints are frequent and usually asymptomatic.
• There is a strong correlation between the amount of FDG uptake and age.4,5,6
• Subclinical inflammatory proliferation in the synovial joint and chronic inflammatory processes is commonly seen in elderly patients.3
154 Part II Clinical Cases
FIGURE14.1.5.
