18F-fluorodeoxyglucose positron emission tomography/ computed tomography of giant cell arteritis with lower extremity involvement in association with polymyalgia rheumatica
An 80-year-old man presented with new-onset pain in the shoulders and lower extremities and elevated serum inflammatory markers. A clinical diagnosis of polymyalgia rheumatica (PMR) was made, but there was a suboptimal response to glucocorticoid therapy, prompting further evaluation. 18F-fluorodeoxy...
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2021-03-01
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| Series: | World Journal of Nuclear Medicine |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.4103/wjnm.WJNM_102_20 |
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| author | Ananya Panda Gregory Wiseman Matthew Koster Kenneth Warrington Geoffrey Johnson |
| author_facet | Ananya Panda Gregory Wiseman Matthew Koster Kenneth Warrington Geoffrey Johnson |
| author_sort | Ananya Panda |
| collection | DOAJ |
| description | An 80-year-old man presented with new-onset pain in the shoulders and lower extremities and elevated serum inflammatory markers. A clinical diagnosis of polymyalgia rheumatica (PMR) was made, but there was a suboptimal response to glucocorticoid therapy, prompting further evaluation. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) revealed intense FDG uptake in the arteries of the bilateral lower extremities, head, and neck, but sparing the aorta, suggestive of an uncommon pattern of giant cell arteritis (GCA). There were also imaging signs consistent with PMR, including FDG uptake in the synovium of large joints. This case highlights the uncommon manifestation of GCA with lower extremity involvement and sparing of the aorta. The combination of FDG PET imaging features and elevated serum markers obviated the need for invasive biopsy. One might also conclude that standard FDG PET/CT imaging protocols covering orbits/vertex to thighs incompletely evaluate the extent of arterial distribution of GCA. |
| format | Article |
| id | doaj-art-724dc875f2d64a6b996eb1a6c05acce6 |
| institution | Kabale University |
| issn | 1450-1147 1607-3312 |
| language | English |
| publishDate | 2021-03-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | World Journal of Nuclear Medicine |
| spelling | doaj-art-724dc875f2d64a6b996eb1a6c05acce62025-08-20T03:48:37ZengThieme Medical and Scientific Publishers Pvt. Ltd.World Journal of Nuclear Medicine1450-11471607-33122021-03-012001909210.4103/wjnm.WJNM_102_2018F-fluorodeoxyglucose positron emission tomography/ computed tomography of giant cell arteritis with lower extremity involvement in association with polymyalgia rheumaticaAnanya Panda0Gregory Wiseman1Matthew Koster2Kenneth Warrington3Geoffrey Johnson4Department of Radiology, Mayo Clinic, Rochester, MN, USADepartment of Radiology, Mayo Clinic, Rochester, MN, USADepartment of Rheumatology, Mayo Clinic, Rochester, MN, USADepartment of Rheumatology, Mayo Clinic, Rochester, MN, USADepartment of Radiology, Mayo Clinic, Rochester, MN, USAAn 80-year-old man presented with new-onset pain in the shoulders and lower extremities and elevated serum inflammatory markers. A clinical diagnosis of polymyalgia rheumatica (PMR) was made, but there was a suboptimal response to glucocorticoid therapy, prompting further evaluation. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) revealed intense FDG uptake in the arteries of the bilateral lower extremities, head, and neck, but sparing the aorta, suggestive of an uncommon pattern of giant cell arteritis (GCA). There were also imaging signs consistent with PMR, including FDG uptake in the synovium of large joints. This case highlights the uncommon manifestation of GCA with lower extremity involvement and sparing of the aorta. The combination of FDG PET imaging features and elevated serum markers obviated the need for invasive biopsy. One might also conclude that standard FDG PET/CT imaging protocols covering orbits/vertex to thighs incompletely evaluate the extent of arterial distribution of GCA.http://www.thieme-connect.de/DOI/DOI?10.4103/wjnm.WJNM_102_20diagnosisdiagnostic imaginggiant cell arteritispolymyalgia rheumaticarheumatic diseasesvasculitis |
| spellingShingle | Ananya Panda Gregory Wiseman Matthew Koster Kenneth Warrington Geoffrey Johnson 18F-fluorodeoxyglucose positron emission tomography/ computed tomography of giant cell arteritis with lower extremity involvement in association with polymyalgia rheumatica World Journal of Nuclear Medicine diagnosis diagnostic imaging giant cell arteritis polymyalgia rheumatica rheumatic diseases vasculitis |
| title | 18F-fluorodeoxyglucose positron emission tomography/ computed tomography of giant cell arteritis with lower extremity involvement in association with polymyalgia rheumatica |
| title_full | 18F-fluorodeoxyglucose positron emission tomography/ computed tomography of giant cell arteritis with lower extremity involvement in association with polymyalgia rheumatica |
| title_fullStr | 18F-fluorodeoxyglucose positron emission tomography/ computed tomography of giant cell arteritis with lower extremity involvement in association with polymyalgia rheumatica |
| title_full_unstemmed | 18F-fluorodeoxyglucose positron emission tomography/ computed tomography of giant cell arteritis with lower extremity involvement in association with polymyalgia rheumatica |
| title_short | 18F-fluorodeoxyglucose positron emission tomography/ computed tomography of giant cell arteritis with lower extremity involvement in association with polymyalgia rheumatica |
| title_sort | 18f fluorodeoxyglucose positron emission tomography computed tomography of giant cell arteritis with lower extremity involvement in association with polymyalgia rheumatica |
| topic | diagnosis diagnostic imaging giant cell arteritis polymyalgia rheumatica rheumatic diseases vasculitis |
| url | http://www.thieme-connect.de/DOI/DOI?10.4103/wjnm.WJNM_102_20 |
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