A case of septic pulmonary embolism associated with renal abscess mimicking pulmonary metastases of renal malignancy
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CASE REPORT
A case of septic pulmonary embolism associated with renal abscess mimicking pulmonary metastases of renal malignancy Jo Sung Jung • Sang Mi Lee • Han Jo Kim Si-Hyong Jang • Jeong Won Lee
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Received: 19 November 2013 / Accepted: 13 January 2014 Ó The Japanese Society of Nuclear Medicine 2014
Abstract We report the case of a 46-year-old woman with acute febrile symptom who had multiple pulmonary nodules and a renal mass. She underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) to find a hidden malignancy and the cause of her fever. FDG PET/CT images demonstrated a renal mass and multiple lung nodules with intense FDG uptake, which was suspicious of a renal malignancy with multiple pulmonary metastatic lesions. CT-guided biopsies of the pulmonary and renal lesions only showed chronic inflammatory infiltrates without evidence of malignancy. She was diagnosed with septic pulmonary embolism from a renal abscess. One month after antibiotic treatment, the follow-up chest and abdomen CT showed improvement of the lung and renal lesions. This is the first case demonstrating the FDG PET/CT finding of septic
J. S. Jung Department of Radiology, Sooncheonhyang University Cheonan Hospital, Cheonan, Republic of Korea S. M. Lee (&) Department of Nuclear Medicine, Sooncheonhyang University Cheonan Hospital, 23-20 Byeongmyeong-dong, Dongnam-gu, Cheonan, Chungcheongnam-do, Republic of Korea e-mail: [email protected] H. J. Kim Department of Internal Medicine, Sooncheonhyang University Cheonan Hospital, Cheonan, Republic of Korea
pulmonary embolism associated with renal abscess in the published literature. Keywords 18F-fluorodeoxyglucose PET Septic pulmonary embolism Renal abscess
Introduction Septic pulmonary embolism is an uncommon disorder that has non-specific clinical and radiological features [1, 2]. The diagnosis of septic pulmonary embolism is usually suggested by the presence of predisposing factors and clinical features such as fever with computed tomography (CT) findings including multiple lung nodules [2, 3]. Clinical and radiologic features at presentation are usually non-specific, and the diagnosis of septic pulmonary embolism is frequently delayed [4]. Most cases of septic emboli originated from bacterial endocarditis or septic thrombophlebitis with infection sources such as periodontal inflammation, urinary tract infection, or infection of catheter [1, 2, 5]. Here, we report the case of a diabetic patient who showed multiple lung nodules and a renal mass with all the masses having increased 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT) mimicking metastatic lung nodules from a renal malignancy. To our knowledge, this is the first report of imaging finding of FDG PET/CT in a patient with septic pulmonary embolism from a renal abscess.
S.-H. Jang Department of Pathology, Sooncheonhyang University Cheonan Hospital, Cheonan, Republic of Korea
Case report
J. W. Lee Department of Nuclear Medicine, Yonsei Univ
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