Widespread vascular inflammation in a patient with antineutrophil cytoplasmic antibody-associated vasculitis as detected by positron emission tomography

2014 
A 47-year-old man had fever, fatigue, abdominal pain, and claudication due to antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Whole-body [18 F] FDG PET/CT scan was performed as a diagnostic procedure, and it revealed abnormal [18 F] FDG accumulation in smalland medium-sized vessels of the upper extremities and in the lower extremities appearing as a tree-root-like [18 F] FDG uptake pattern (Panel A). Increased [18 F] FDG uptake in vertebral bone marrow and the spleen was observed due to hematopoietic stimulation. For comparison, two different [18 F] FDG PET/CT scans are presented. A 76-year-old woman had an atypical [18 F] FDG uptake pattern in the larger arteries, which indicated giant cell vasculitis (Panel B). A 39-year-old man had Staphylococcus aureus septicaemia. He had no [18 F] FDG metabolic activity in vessel walls, but the activation of axillary lymph nodes and metastatic infectious foci in the left leg and spleen was observed (Panel C). [F] FDG PET/CT is a useful tool for evaluating the distribution of inflammation and infection, as in our case. It can detect the affected organs and also show unexpected localizations of ANCA-associated vasculitis [1].
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