Acute saddle pulmonary embolism on ¹⁸F‐FDG PET/CT: diagnosis by functional imaging

Abstract

18F‐labelled fluoro‐2‐deoxyglucose positron emission tomography/computed tomography (18F‐FDG PET/CT) is used extensively in the setting of cancer staging and in assessing cancer treatment response. Oncology patients have a sevenfold risk of developing pulmonary embolism (PE) due to underlying activation of the haemostatic system and anti‐cancer therapy inducing a hypercoagulable state. The diagnosis of PE on 18F‐FDG PET/CT is challenging, particularly in the absence of intravenous contrast. The case of a female patient undergoing treatment for advanced diffuse large B‐cell lymphoma is presented. The ancillary signs of PE are illustrated on consecutive non‐contrast‐enhanced 18F‐FDG PET/CT scans. The signs include the “rim sign” relating to regions of pulmonary infarction and abnormal cardiac uptake indicating right heart strain. The diagnosis was confirmed on CT pulmonary angiography which demonstrated extensive PE, including a saddle embolus.

Saddle Pulmonary Embolism in Patients with Cancer in the Era of Incidental Events: Clinical Findings and Outcomes in a Single Centre Cohort

“…There is scarce information regarding the prevalence, clinical characteristics, and outcomes of patients with cancer and saddle PE apart from a few case reports in patients with suspected PE 23 24 and, more recently, in patients with UPE. 25 26 …”

Diagnosis of Bleeding Disorders in Adolescents Hospitalized for Heavy Menstrual Bleeding

“…There is scarce information regarding the prevalence, clinical characteristics, and outcomes of patients with cancer and saddle PE apart from a few case reports in patients with suspected PE 23,24 and, more recently, in patients with UPE. 25,26 The aim of the present study was to assess the prevalence, clinical findings, and short-term outcomes of patients with cancer and saddle PE including acute symptomatic and unsuspected events.…”