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INTERESTING IMAGE
Year : 2021  |  Volume : 36  |  Issue : 1  |  Page : 80-81  

Positron emission tomography/computed tomography alert finding in an esophageal cancer patient


Department of Nuclear Medicine, Theageneio Cancer Hospital, Thessaloniki, Greece

Date of Submission05-Apr-2020
Date of Decision07-Apr-2020
Date of Acceptance13-May-2020
Date of Web Publication04-Mar-2021

Correspondence Address:
Dr. Anna Paschali
Alexandrou Simeonidi 2, 54007, Thessaloniki
Greece
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_63_20

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   Abstract 


Emergency pathologies often accompany malignancies. We herein report a case of pulmonary abscess in a patient with esophageal cancer which was depicted during the F-18-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) staging study. The patient's history of recent dilatation of the cancer stenosis in adjunct to the previous CT lung imaging, which was normal, made evident the diagnosis of the pulmonary abscess due to the perforation of the esophageal neoplasm. This life-threatening condition was promptly referred and successfully managed.

Keywords: Esophageal cancer, F-18-fluorodeoxyglucose positron emission tomography/computed tomography, pulmonary abscess


How to cite this article:
Panagiotidis E, Paschali A, Chatzipavlidou V. Positron emission tomography/computed tomography alert finding in an esophageal cancer patient. Indian J Nucl Med 2021;36:80-1

How to cite this URL:
Panagiotidis E, Paschali A, Chatzipavlidou V. Positron emission tomography/computed tomography alert finding in an esophageal cancer patient. Indian J Nucl Med [serial online] 2021 [cited 2021 Apr 21];36:80-1. Available from: https://www.ijnm.in/text.asp?2021/36/1/80/310798



A 55-year-old male with a recent diagnosis of adenocarcinoma of the lower third of the esophagus underwent F-18-fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT), which showed a large, thick-walled, cavitary lesion in the right lower lobe with intense FDG uptake (maximum Standardized Uptake Value [SUVmax] =12.2), abutting the esophageal neoplasm (SUVmax = 5.5) [Figure 1]. The lung lesion was new compared to the CT study performed a month earlier, while in the meanwhile, the patient underwent endoscopic biopsy and dilatation to relieve from dysphagia. The patient, who was alcoholic, presented with a complaint of recent-onset intermittent coughing, especially when lying, but he denied fever or chills. No clear fistula formation was evident in the low-dose unenhanced CT part of the study. Taking together the imaging findings and clinical history, a diagnosis of lung abscess was made, presumably due to perforation induced by the mechanical dilatation of the cancer stenosis and spontaneous esophagopulmonary fistula formation. The patient was promptly referred to the oncology department and was started on antibiotic therapy. A follow-up CT performed 20 days later showed resolution of the lung abscess [Figure 2]. This is a rare and life-threatening condition, which radiologists and nuclear medicine physicians should recognize and refer the patient for urgent management. Only a few similar cases have been published so far,[1],[2],[3],[4],[5],[6],[7],[8] highlighting the importance of F-18 FDG PET/CT in detecting this life-threatening condition.
Figure 1: F-18-fluorodeoxyglucose positron emission tomography/computed tomography, axial and coronal slices

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Figure 2: Computed tomography thorax postantibiotic therapy, axial and coronal slices

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Puranik AD, Purandare NC, Agrawal A, Shah S, Rangarajan V. Broncho-esophageal fistula leading to lung abscess: A life-threatening emergency detected on FDG PET/CT in a case of carcinoma of middle third esophagus. Indian J Nucl Med 2013;28:176-7.  Back to cited text no. 1
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2.
Rehders A, Baseras B, Telan L, Al-Sharahbani F, Angenendt S, Ghadimi MH, et al. Esophageal cancer complicated by esophagopulmonary fistula and lung abscess formation: A surgical approach. Thorac Cancer 2014;5:468-71.  Back to cited text no. 2
    
3.
Satija L, Joshi P, George R, Singh S. An unusual case of malignant oesophago-pulmonary fistula diagnosed by multidetector computed tomography. Med J Armed Forces India 2012;68:72-4.  Back to cited text no. 3
    
4.
Burt M, Diehl W, Martini N, Bains MS, Ginsberg RJ, McCormack PM, et al. Malignant esophagorespiratory fistula: Management options and survival. Ann Thorac Surg 1991;52:1222-8.  Back to cited text no. 4
    
5.
Rodriguez AN, Diaz-Jimenez JP. Malignant respiratory-digestive fistulas. Curr Opin Pulm Med 2010;16:329-33.  Back to cited text no. 5
    
6.
Balazs A, Galambos Z, Kupcsulik PK. Characteristics of esophagorespiratory fistulas resulting from esophageal cancers: A single-center study on 243 cases in a 20-year period. World J Surg 2009;33:994-1001.  Back to cited text no. 6
    
7.
Aggarwal D, Mohapatra PR, Malhotra B. Acquired bronchoesophageal fistula. Lung India 2009;26:24-5.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Argüder E, Aykun G, Karalezli A, Hasanoğlu HC. Bronchoesophageal fistula. J Bronchology Interv Pulmonol 2012;19:47-9.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]



 

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