Indian Journal of Nuclear Medicine
Home | About IJNM | Search | Current Issue | Past Issues | Instructions | Ahead of Print | Online submissionLogin 
Indian Journal of Nuclear Medicine
  Editorial Board | Subscribe | Advertise | Contact
Users Online: 56 Print this page  Email this page Small font size Default font size Increase font size


 
 Table of Contents     
INTERESTING IMAGES
Year : 2014  |  Volume : 29  |  Issue : 4  |  Page : 289-290  

Marked uptake of fluorodeoxyglucose in a vocal cord after medialization: Acute and subacute positron emission tomography/computed tomography findings


Department of Nuclear Medicine, School of Medicine, Marmara University, Istanbul, Turkey

Date of Web Publication11-Oct-2014

Correspondence Address:
Salih Ozguven
Department of Nuclear Medicine, School of Medicine, Marmara University, Istanbul 34690
Turkey
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.142656

Rights and Permissions
   Abstract 

A 60-year-old male who underwent left upper lobectomy because of recently diagnosed lung cancer was admitted to the nuclear medicine department. A whole body fluorodeoxyglucose positron emission tomography/computed tomography (CT) that was performed for staging purposes, revealed an intense hypermetabolism in left vocal cord region corresponding with hyperdense mass-like material on CT scan.

Keywords: Fluorodeoxyglucose, positron emission tomography/computed tomography, vocal cord medialization


How to cite this article:
Ozguven S, Dede F, Erdil TY, Turoglu HT. Marked uptake of fluorodeoxyglucose in a vocal cord after medialization: Acute and subacute positron emission tomography/computed tomography findings. Indian J Nucl Med 2014;29:289-90

How to cite this URL:
Ozguven S, Dede F, Erdil TY, Turoglu HT. Marked uptake of fluorodeoxyglucose in a vocal cord after medialization: Acute and subacute positron emission tomography/computed tomography findings. Indian J Nucl Med [serial online] 2014 [cited 2019 Dec 12];29:289-90. Available from: http://www.ijnm.in/text.asp?2014/29/4/289/142656

A 60-year-old male who underwent left upper lobectomy because of recently diagnosed lung cancer was admitted to the nuclear medicine department. A whole body fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) that was performed for staging purposes, revealed no abnormal FDG uptake in the thorax to indicate residual disease. There was a focus of intense hypermetabolism [maximum standardized uptake value (SUVmax: 9.2)] in left vocal cord region. CT scan showed hyperdense mass-like material that overlapped with hypermetabolism in the left vocal cord [Figure 1]a]. Further investigation to clarify the diagnosis revealed, teflon injection to left vocal cord as a medialization procedure in ENT Department 1 week ago to treat postoperative hoarseness due to incision of recurrent laryngeal nerve was learned. After 3 months, follow-up FDG PET/CT scan showed persistence of similar findings in left vocal cord [Figure 1]b, SUVmax: 8.7]. The expected FDG PET/CT finding in vocal cord paralysis is increased FDG uptake involving the nonaffected vocal cord due to hyperfunction. However, in our case there was an opposite condition. This unexpected situation could be compatible with primary laryngeal tumor due to the patient's excessive smoking and lung carcinoma history. Nevertheless, with anamnesia and typical CT images described below, differential diagnosis of benign inflamation due to medialization procedure was performed. In the literature; findings of medialization on FDG PET/CT scans was reported in only a few cases with history of esophagus, thyroid and lung carcinomas. [1],[2],[3] When these few cases were analysed, presentation of only chronic (6 months to 6 years) inflammatory changes were seen on FDG PET/CT images. Teflon that was injected during medialization process resulted in an inflammatory response characterized by granulomatous reaction (foreign-body granulomatous reaction) as shown in the literature. [2] This increased FDG uptake is due to chronic inflammatory response and FDG accumulation in macrophage-laden granulomas. [4] Similar to chronic changes, intense hypermetabolism due to medialization process was also seen in both acute and subacute periods without any interval change in our case. It could be related with neutrophil activation which is characterized metabolically by an increase in glucose utilization per cell and thus, increased FDG uptake. [5] CT scan can distinguish various types of vocal cord augmentation ("medialization"). Silastic implants are recognized by their hyperattenuated triangular configuration. Gore-Tex implants have unique heterogeneous attenuation with irregular medial margins. Fat injection has a low-attenuation ovoid mass. Teflon injections are hyperattenuated and mass-like and should not be mistaken for tumor. [6] Although the typical CT images of the materials used for vocal cord medialization process is well defined, their corresponding FDG uptake patterns except teflon not had been reported yet. In conclusion; when nuclear medicine physicians are faced with asymmetrical vocal cord hypermetabolizm; in addition to primary laryngeal tumor or unilateral vocal cord paralysis, the possibility of vocal cord medialization should also be kept in mind.
Figure 1: Focus of intense hypermetabolism overlapping hyperdense mass-like material in the left vocal cord region (arrows) were seen on both Initial staging (a) and follow-up (b) axial slices of the fl uorodeoxyglucose, positron emission tomography/computed tomography

Click here to view


 
   References Top

1.
Modi D, Fulham MJ, Mohamed A, Havas TE. Markedly increased FDG uptake in a vocal cord after medialization with Teflon: PET/CT findings. Clin Nucl Med 2005;30:45-7.  Back to cited text no. 1
    
2.
Yeretsian RA, Blodgett TM, Branstetter BF 4 th , Roberts MM, Meltzer CC. Teflon-induced granuloma: A false-positive finding with PET resolved with combined PET and CT. AJNR Am J Neuroradiol 2003;24:1164-6.  Back to cited text no. 2
    
3.
Heller MT, Meltzer CC, Fukui MB, Rosen CA, Chander S, Martinelli MA, et al. Superphysiologic FDG uptake in the non-paralyzed vocal cord. Resolution of a false-positive PET result with combined PET-CT imaging. Clin Positron Imaging 2000;3:207-11.  Back to cited text no. 3
    
4.
Havas T, Lowinger D, Priestley J. Unilateral vocal fold paralysis: Causes, options and outcomes. Aust N Z J Surg 1999;69:509-13.  Back to cited text no. 4
    
5.
Jones HA, Cadwallader KA, White JF, Uddin M, Peters AM, Chilvers ER. Dissociation between respiratory burst activity and deoxyglucose uptake in human neutrophil granulocytes: Implications for interpretation of (18) F-FDG PET images. J Nucl Med 2002;43:652-7.  Back to cited text no. 5
    
6.
Kumar VA, Lewin JS, Ginsberg LE. CT assessment of vocal cord medialization. AJNR Am J Neuroradiol 2006;27:1643-6.  Back to cited text no. 6
    


    Figures

  [Figure 1]



 

Top
  
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
    References
    Article Figures

 Article Access Statistics
    Viewed525    
    Printed14    
    Emailed0    
    PDF Downloaded45    
    Comments [Add]    

Recommend this journal