Generalized Large Vessel Arteritis Visualized by 18Fluorodeoxyglucose-Positron Emission Tomography
This previously healthy 81-year-old man with recurrent fever up to 38.8°C and an erythrocyte sedimentation rate of more than 85 mm/h had no pain and did not respond to empirical treatment with antibiotics. Imaging by computerized tomography, thyroid and whole body 99mTc-MIBI scintigraphy (because of pre-diagnosed hyperparathyroidism), gastroscopy, colonoscopy, and bone marrow aspiration were unremarkable. Only whole body 18fluorodeoxyglucose (18F-FDG)-positron emission tomography (PET) revealed markedly increased tracer uptake along the aorta and the adjacent large artery walls (Figure). Fever ceased only hours after the first dose of corticosteroids, which were gradually tapered down during the following weeks. After 3 months, a second 18F-FDG-PET scan showed physiological 18F-FDG uptake in the large vessel walls and increased 18F-FDG uptake in some cervical and upper limb muscles of the right side and the stomach (Figure, F). During a year of follow-up, the patient did well with low-dose corticosteroids and 100 mg azathioprine.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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