Objectives18F-choline is a useful tracer for detecting tumours with high lipogenesis. Knowledge of its biodistribution pattern is essential to recognise physiological variants. The aim of this study was to describe the physiologic distribution of 18F-choline and pitfalls in patients with breast cancer.MethodsTwenty-one consecutive patients with breast cancer (10 premenopausal and 11 postmenopausal women; mean age, 52.82 ± 10.71 years) underwent 18F-choline positron emission tomography (PET)/computed tomography (CT) for staging. Whole-body PET/CT was acquired after 40 minutes of 18F-choline uptake. Acquired PET images were measured semiquantitatively.ResultsAll patients showed pitfalls unrelated to breast cancer. These findings were predominantly caused by physiological glandular uptake in the liver, spleen, pancreas, bowels, axial skeleton (85%-100%), inflammation and benign changes (4.76%), appendicular skeleton (4.76%–19.049%), and site contamination (61.9%). In <1%, a concomitant metastatic neoplasm was found. The breast showed higher physiological uptake in premenopausal compared with postmenopausal woman (18F-choline maximum standardised uptake values [g/dL] of the right breast = 2.04 ± 0.404 vs 1.59 ± 0.97 and left breast = 2.00 ± 0.56 vs 1.93 ± 1.28, respectively).Conclusion18F-choline uptake was higher in premenopausal women. Physiological 18F-choline uptake was observed in many sites, representing possible pathologies.
Pulmonary tuberculosis (PTB) is common in tropical country like Malaysia. Prolonged PTB infection may lead to mycotic pulmonary artery pseudoaneurysm (PAP). We report a case of childhood non-tuberculous pulmonary infection causing mycotic PAP which resolved spontaneously after antibiotics therapy. A 1 year 6 months old girl underlying Down syndrome presented with prolonged fever for two weeks , cough and breathlessness. Her leucocytes count were elevated and she developed several hypotensive episodes secondary to septicaemia. Chest radiograph showed loculated right sided pleural effusion. Ultrasound revealed complex pleural collection and initial aspiration revealed a thick stale blood. Thinking of possible vascular cause, ultrasound able to locate a well-defined rounded structure with high flow velocity seen on Doppler ultrasound consistent with pseudoaneurysm and CT thorax confirmed the findings. Pulmonary artery angiogram prior to embolization revealed no evidence of abnormal vasculature or contrast blush at the region of interest. Complimentary ultrasound showed evidence of spontaneous thrombosis within the pseudoaneurysm.Non-tuberculous PAP is a rare but possible life-threatening sequela of pneumonia. Pleural drainage in a haemothorax with concomitant mycotic thoracic pseudoaneurysm may cause loss of pressure tamponade and will end up with devastating consequences. Careful ultrasound image acquisition must be made by the attending radiologist prior to pleural drainage.
We reported a rare case of a spontaneous rupture of an intratumoral pseudoaneurysm in a giant renal angiomyolipoma of a 52-year-old lady. The initial presentation was a sudden onset of right hypochondriac pain, nausea, and vomiting. CT scan revealed large heterogenous exophytic enhancing mass with mixed solid and fat density within, arising from the right kidney likely represent a giant right renal angiomyolipoma. There is associated right perinephric hematoma and active bleeding within the mass. No features suggestive of tuberous sclerosis. Subsequent right renal angiogram revealed a pseudoaneurysm of an inferior segmental right renal artery and emergency embolization was done with successful obliteration of the aneurysmal sac and devascularization of the mass.
Bronchial artery embolization was first performed in 1973 by Remy et al with widespread acceptance since then. Multi-detector computed tomography (MDCT) CT angiography (CTA) is currently the gold standard imaging modality used to identify the site and cause of bleeding in patient presented with haemoptysis. Bronchial artery anatomies and precise location can be obtained by scrutinizing CTA prior to interventional procedures. CTA has the advantage of not only can preclude the need of digital subtraction angiography (DSA) in inappropriate cases, but also can shorten the intervention procedure timing. We present a case of false negative bronchial artery caliber seen on MDCT which was abnormal in DSA.
Lipiodol (also known as ethiodized oil) is an iodinated poppy seed oil first synthesized in 1901 for therapeutic purposes. The use of lipiodol in lymphangiography in later date has gain popularity as this agent tend to retain in the lymphatic system as opposed to other iodinated hydrosoluble contrast media that diffuse out of lymphatic system rapidly. Over the course of several days and weeks, the iodine within the lipiodol is released by enzymatic cleavage and the fat molecules are degraded. In our case, there is retention of lipiodol in the left axilla which showed as group of round calcifications in Mammogram. This has raised the suspicion of talcum powder usage for the reporting radiologist without revisiting the past surgical and medical procedure. Even though lipiodol washout is a time-dependant process, it can retain in our body or site of injection as long as few years as evidenced in our case.
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