A 46 yrs old male presents with persistent abdominal pain for 1 yr. Abdominal CT found a soft tissue mass in the pancreatic tail and a hypodense liver lesion which was negative for malignancy on biopsy. Chest CT was performed before diagnostic laparoscopy with possible resection, and showed a left upper lobe nodule, mediastinal and hilar lymphadenopathy. PET-CT was performed for further characterization.

PET-CT images demonstrate symmetric increased FDG uptake in mediastinal and hilar regions (maximum SUV measuring 5.4), a pattern consistent with sarcoidosis The left upper lobe nodule did not show FDG uptake. Faint FDG uptake was seen in the pancreatic tail mass.

1. Sarcoid-like reaction to malignancy on whole-body integrated (18)F-FDG PET/CT: prevalence and disease pattern. Chowdhury FU, Sheerin F, Bradley KM, Gleeson FV. Clin Radiol. 2009 Jul;64(7):675-81.

2. Imaging features of sarcoidosis on MDCT, FDG PET, and PET/CT. Prabhakar HB, Rabinowitz CB, Gibbons FK, O’Donnell WJ, Shepard JA, Aquino SL. AJR Am J Roentgenol. 2008 Mar;190(3 Suppl):S1-6.

3. Bilateral hilar foci on 18F-FDG PET scan in patients without lung cancer: variables associated with benign and malignant etiology. Karam M, Roberts-Klein S, Shet N, Chang J, Feustel P.J Nucl Med. 2008 Sep;49(9):1429-36.

This case was compiled by Dr. David He, BCM