Abnormal FDG uptake predicting the instability of thoracic aortic aneurysms
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Department of Cardiovascular Medicine, Hokkaido University Hospital, Sapporo, Japan Department of Cardiovascular and Thoracic Surgery, Hokkaido University Hospital, Sapporo, Japan Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
Received Aug 4, 2019; accepted Aug 16, 2019 doi:10.1007/s12350-019-01871-0
A 70-year-old man admitted with congestive heart failure, who had been diagnosed with dilated cardiomyopathy and underwent pacemaker implantation 9 years previously. After the admission, he developed fever (axillary body temperature 37.9 °C) without abnormal physical examination findings. Contrast-enhanced computed tomography (CT) showed thickening of the descending aortic outer membrane just above the diaphragm, referred to as a ‘‘mantle sign’’ (Figure 1A, B, arrows). 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT 4 days after fever, which was performed to evaluate infectious aortic aneurysm, showed abnormal FDG uptake (maximum standardized uptake value, 8.6) at the aortic wall (Figure 1C to E), which indicated the instability of aneurysm. On the next day of FDG PET, CT revealed a rapid expansion in the diameter of the aorta (3 mm per 5 days) with penetrating atherosclerotic ulcer (PAU) (Figure 1F to G, arrows), and then he underwent emergent aortic aneurysm repair to prevent rupture. As
Reprint requests: Kiwamu Kamiya, MD, PhD, Department of Cardiovascular Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo 060-8648, Japan; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2019 American Society of Nuclear Cardiology.
intraoperative findings, the aneurysm wall was thickened in an edematous shape, and a mural thrombus was observed inside of aneurysm. There was a partial intimal defect but not an outer membrane rupture, which was consistent with PAU. Pleural fluid and thrombus cultures were negative, so no bacterial infection was determined. In the pathological findings, mild lymphocyte infiltration and few lymphoid follicles were observed in the outer membrane in Hematoxylin–Eosin staining (Figure 2A, B, arrows). Inflammation plays an important role in the pathophysiology of aortic aneurysms,1 and there are cases with high inflammation activity regardless of the aneurysm diameter.2 Abnormal FDG uptake in aortic aneurysm may be useful for predicting the risk of expansion and rupture.3 This case may highlight that abnormal FDG uptake has an incremental value for predicting a rapid exacerbation and wall instability of aortic aneurysm.
Chiba et al Predicting the instability of thoracic aortic aneurysms
Journal of Nuclear CardiologyÒ
Figure 1. Contrast-enhanced CT performed during fever showed thickening of the descending aortic outer membrane just above the diaphragm, like a mantle sign (A to B, arrows). 18F-FDG PET/CT 4 days after fever showed abnormal FDG uptake (SUVmax, 8.6) at the aortic wall (C to E, arrows), which indicated the instability of aneurysm. On the next day of FDG PET, CT revealed the progression of P
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