Periaortic Hypermetabolism on 18 F-FDG PET/CT in a Rapidly Progressive Thoracic Aortic Aneurysm.
Anselm Johannes Schlemmer, Ann-Katrin Kaufmann-Bühler, Marijan Pušeljić et al.
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Case in brief
An 80-year-old man with a descending thoracic aortic aneurysm and recent pancreaticoduodenectomy for pancreatic adenocarcinoma underwent 18F-FDG PET/CT for elevated inflammatory markers. Imaging showed intense periaortic uptake, new soft-tissue thickening, and aneurysm enlargement compared with prior CT; a hypermetabolic hepatic lesion was later diagnosed as a liver abscess. CT obtained for chest pain one month later showed further aneurysm enlargement and progressive mural abnormalities. An infected aneurysm was suspected, with inflammatory aneurysm also considered.
What made this case unusual
Marked periaortic FDG uptake accompanied new soft-tissue thickening and rapid aneurysm enlargement, identifying metabolically active wall disease before further progression was seen on CT.
Diagnostic / clinical pearl
In a patient with an enlarging thoracic aortic aneurysm and elevated inflammatory markers, periaortic FDG uptake with new mural or soft-tissue abnormalities may signal active aneurysmal wall disease and raise concern for infection.