A case of COVID-19 lung infection first detected by [18F]FDG PET-CT

Excerpt

An 82-year-old man with a history of the adenocarcinoma of colon who had undergone sigmoidectomy followed by adjuvant chemotherapy 8 years ago presented with fatigue and myalgia for 10 days. On laboratory work-up, mildly elevated carcinoembryonic antigen (CEA = 9.8 ng/mL, normal range up to 5 ng/mL) was detected. Total colonoscopy showed no remarkable finding. The patient was therefore referred to our institute to obtain an [18F]FDG PET-CT scan for evaluation of recurrence. [18F]FDG PET-CT scan was performed per institutional standard protocol. On [18F]FDG PET-CT scan (a, MIP image), no hypermetabolic focus was detected in the pelvic or abdominal areas to suggest a malignant focus; physiologic activity was seen in the bowel (black arrow). There were, however, foci of moderate to severely increased FDG activity with an SUVmax of 8.6 (SUVmax ranging from 1.5 to 8.6 in the left lung and 1.2 to 8.3 in the right lung) in both lungs (a, MIP image; b–d, axial fused PET-CT; red arrows) corresponding to the multiple peripheral bilateral pulmonary patchy ground-glass opacities on CT (e–g, axial CT; green arrows) with hypermetabolic mediastinal lymph nodes (SUVmax of 4.5). Despite lack of typical symptoms of coronavirus disease 2019 (COVID-19) infection, the morphological pattern on computed tomography was highly suggestive of a COVID-19 infection, given the recent outbreak of this novel coronavirus globally [1]. …