PMC5030371_01
A, Multiple bilateral cavitating pulmonary lesions. B, Image 3 months after treatment: there is a reduction in the overall size of the nodular pulmonary lesions, with residual millimetric changes.
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Given the patient's history of surgery for vascular disease, abdominal computed tomography (CT) was performed; this revealed the presence of a concentric soft tissue mass around the infrarenal abdominal aorta associated with left-sided ureterohydronephrosis, in addition to multiple pulmonary nodules and a bilateral pleural effusion (Fig. 1A). One month after starting treatment we observed a radiological improvement with a marked reduction in the size of all the multicentric nodular pulmonary lesions and of the concentric soft-tissue cuff around the infrarenal abdominal aorta (Fig. 1B).
Positron emission tomography-computed tomography. A, Pathological increase in glucose metabolism in the soft tissue mass surrounding the infrarenal abdominal aorta. B, Bilateral hypermeabolic pulmonary modules.
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Positron emission tomography-CT (PET-CT) revealed a pathological increase in glucose metabolism in the pulmonary nodules (SUVmax, 6.92), as well as an intense pathological increase in glucose metabolism in the retroperitoneal soft tissue mass surrounding the infrarenal abdominal aorta down to the level of the bifurcation, with an SUVmax of 6.3. (Fig. 2).
Biopsy of abdominal para-aortic mass. Acute inflammation and chronic granulomatous suppurative necrotizing.
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Histology revealed acute suppurative and chronic inflammation with necrotizing granulomas and areas suggestive of vasculitis, but no bacterial or mycobacterial growth (see Fig. 3).