PMC5291561_01
Whole-body F-18 FDG PET/CT imaging on a patient with advanced right papillary thyroid carcinoma. (A) 3D-MIP images demonstrated widespread increased FDG uptake regions in the body. (B, C) Selected axial and coronal PET/CT images show that an ill-defined hypodensity mass with inhomogeneous intense FDG uptake in the lower pole of right thyroid lobe (red arrow), measuring 2.0 cm x 3.3 cm x 4.0 cm, SUVmax = 7.0. Selected PET/CT images also show that extensive markedly FDG-avid sites in regional lymph nodes (D-G), bones (H, I), and skeletal muscles (J, K). Imaging findings were highly consistent with advanced thyroid carcinoma with widespread metastases in the body. 3D-MIP = 3-dimensional maximum intensity projection, FDG = fluorodeoxyglucose, PET/CT = positron emission tomography/computed tomography, SUVmax = maximum of standard uptake value.
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F1
Whole-body F-18 FDG PET/CT images showed an ill-defined hypodensity mass with inhomogeneous intense FDG uptake in the lower pole of right thyroidal lobe (Figure 1 A-C), with widespread FDG-avid regions in regional lymph nodes (Figure 1 D-G), bones (Figure 1 H-I), skeletal muscles (Figure 1 J-K), and 3 intense FDG-avid metastases in 2 equal-volume masses in the right upper abdomen (Figure 2).
PSS with multiple splenic metastases was presented. (A, B) FDG PET/CT images showed that 2 spleens were located in right abdomen with 3 hypermetabolic foci (white arrow), suggesting splenic metastases. (A-D) Right-sided stomach (yellow arrow), PPV (blue arrow), a short pancreas in the absence of body and tail (red arrow), a midline liver, and malrotation of gut are also presented. These findings are consistent with the diagnosis of PSS with multiple splenic metastases. FDG = fluorodeoxyglucose, PET/CT = positron emission tomography/computed tomography, PPV = preduodenal portal vein, PSS = polysplenia syndrome.
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F2
Whole-body F-18 FDG PET/CT images showed an ill-defined hypodensity mass with inhomogeneous intense FDG uptake in the lower pole of right thyroidal lobe (Figure 1 A-C), with widespread FDG-avid regions in regional lymph nodes (Figure 1 D-G), bones (Figure 1 H-I), skeletal muscles (Figure 1 J-K), and 3 intense FDG-avid metastases in 2 equal-volume masses in the right upper abdomen (Figure 2). Other imaging findings included a right-sided stomach, a middle line liver, a short pancreas in the absence of body and tail, preduodenal portal vein (PPV), and malrotation of gut (Figures 2 and 4).
Splenic vessels were observed on FDG PET/CT. (A, B) Splenic artery (red arrow) and splenic vein (blue arrow) are demonstrated in right upper abdomen on FDG PET/CT images. FDG = fluorodeoxyglucose, PET/CT = positron emission tomography/computed tomography.
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F3
The splenic vessels identified by FDG PET/CT images help us to prove that these 2 right-sided masses are actually multiple spleens (Figure 3).
Azygos and hemiazygos continuation of IVC presented on FDG PET/CT. (A) Enlarged azygos arch is paralleling the aorta as it drains into the SVC (white arrow). (B) Enlarged hemiazygos drains into the azygos vein at approximately the ninth thoracic vertebral level (red arrow). (C,D) Enlarged hemiazygos lies on the left side of the aorta (Blue arrow). The intrahepatic portion of the IVC is not identified. Other anomalies including multiple right-sided spleens, right-sided stomach, a short pancreas, PPV, and malrotation of gut were also noted. FDG = fluorodeoxyglucose, IVC = inferior vena cava, PET/CT = positron emission tomography/computed tomography, PPV = preduodenal portal vein, SVC = superior vena cava.
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F4
PET/CT images also showed the findings of azygos and hemiazygos continuation of the IVC with the absence of the hepatic segment (Figure 4), which was the most frequent finding of vascular anomalies in PSS. Other imaging findings included a right-sided stomach, a middle line liver, a short pancreas in the absence of body and tail, preduodenal portal vein (PPV), and malrotation of gut (Figures 2 and 4).