Balanced double aortic arch with late-onset symptoms detected on 18F-FDG PET/CT in an octogenarian with advanced prostate cancer: A case report.
Qiang Wei, Panhui Liu, Yinghua Wu
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Case in brief
An 80-year-old man with advanced prostate cancer underwent 18F-FDG PET/CT for staging. He reported dysuria and back pain for more than a year, with mild intermittent swallowing discomfort. Imaging showed FDG-avid bone metastases and bilateral aortic arch components beside the tracheoesophageal region, with uptake matching the aortic blood pool. Three-dimensional rendering confirmed a balanced double aortic arch forming a complete vascular ring. The characteristic PET/CT findings were considered sufficient, so CT angiography and DAA-directed treatment were not pursued. Conservative management was recommended; at approximately 6 months, his swallowing discomfort remained stable.
What made this case unusual
The balanced double aortic arch was detected in an octogenarian during oncologic PET/CT, despite only mild intermittent swallowing discomfort; its blood-pool-level uptake and continuity with the aortic system helped identify it as vascular rather than malignant mediastinal disease.
Diagnostic / clinical pearl
A tubular mediastinal structure with FDG uptake equivalent to the aortic blood pool and continuity with the aorta should prompt consideration of a vascular anomaly, including double aortic arch, rather than being mistaken for malignant disease.