Four Chamber FDG Uptake in the Heart

Abstract

A 57-year-old-male presented for whole-body PET with CT for restaging of lung cancer. Besides revealing postradiation changes, we noticed an unusual pattern of FDG uptake in the myocardium, with prominent metabolic uptake involving 4 chambers of the heart. Later that day, the patient was referred to the emergency department for increased heart rate, but otherwise asymptomatic. CT angiography was performed, which showed scattered filling defects in bilateral pulmonary arteries consistent with pulmonary embolism. The finding of prominent FDG uptake involving all cardiac chambers in this patient is likely related to heart strain caused by acute pulmonary embolism.

Growing applications of FDG PET-CT imaging in non-oncologic conditions

“…Abnormal patterns of cardiac FDG activity can be noted in a variety of other conditions such as lipomatous hypertrophy of the interatrial septum, epicardial and pericardial fat, increased atrial activity associated with atrial fibrillation or a prominent crista terminalis, endocarditis, myocarditis, pericarditis, etc [84] . Prominent FDG uptake involving all cardiac chambers may be also related to heart strain caused by acute pulmonary embolism [85] . The modality is also accurate for detecting acute symptomatic, proximal deep vein thrombosis.…”

Features of non-malignant thoracic lesions on F-18 FDG PET/CT scan

“…F-18 FDG uptake by atrial appendages or atria is related to atrial fibrillation or overload physiology. The less frequent tracer uptake by ventricles or simultaneously by all chambers of the heart may be secondary to pressure overload or underlying valvular heart diseases [8] . Correlation with additional cardiac imaging (CT, echocardiography, MRI) may be useful to distinguish benign cardiac uptake from metastatic tumor and mediastinal lymphadenopathy [9] (see Figure 3).…”