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Case ReportImages in Rheumatology

Cardiac and Pulmonary Artery Involvement Detected by 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Large-vessel Giant Cell Arteritis

RAFFAELLA UGOLINI, FRANCESCO MURATORE and CARLO SALVARANI
The Journal of Rheumatology November 2018, 45 (11) 1603-1604; DOI: https://doi.org/10.3899/jrheum.180061
RAFFAELLA UGOLINI
Rheumatology Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia;
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FRANCESCO MURATORE
Rheumatology Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, and University of Modena and Reggio Emilia;
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  • For correspondence: francesco.muratore@ausl.re.it
CARLO SALVARANI
Rheumatology Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Italy, and University of Modena and Reggio Emilia, Reggio Emilia, Italy.
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Cardiac and pulmonary artery involvement have been only rarely described in giant cell arteritis1,2. Further, the role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for evaluating pulmonary artery involvement in large-vessel vasculitis has not been investigated.

The patient, a 58-year-old woman with a 4-month history of low-grade fever, asthenia, and weight loss presented to the emergency department of our hospital for syncope. Electrocardiogram showed a third-degree atrioventricular block requiring the implantation of a permanent pacemaker. Blood test revealed elevation of acute-phase reactants (C-reactive protein 100 mg/l, erythrocyte sedimentation rate 113 mm/1st h) and anemia of chronic disease (hemoglobin 10 g/dl). An initial diagnostic workup for fever of unknown origin including serologic tests, blood and urine cultures, QuantiFERON-TB gold, chest radiograph, abdominal and pelvic ultrasound, and echocardiogram were negative. A whole-body FDG-PET/CT scanning and a chest angio-CT showed inflammatory involvement of the aortic arch, the origin of the epiaortic vessels, the pulmonary artery, and 2 cardiac areas (Figure 1). These findings were consistent with large-vessel giant cell arteritis with cardiac and pulmonary artery involvement3. Cardiac magnetic resonance imaging was not performed because of recent permanent pacemaker implantation. High-dose glucocorticoid was started (prednisone 1 mg/kg/day) along with interleukin 6 inhibitor (tocilizumab 162 mg/week), with remission of symptoms and normalization of blood test.

Figure 1.
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Figure 1.

FDG-PET/CT scanning shows (arrows) increased FDG uptake at the origin of the brachiocephalic trunk and left carotid artery (a), the central pulmonary artery (b), and 2 cardiac areas between aortic valve and left atrium (c). Chest angio-CT shows (arrows) wall thickening of the central pulmonary artery (d) and aortic arch (e). FDG-PET/CT: 18F-fluorodeoxyglucose positron emission tomography/computed tomography.

This case demonstrates the utility of FDG-PET/CT to detect cardiac and pulmonary artery inflammation in patients with large-vessel vasculitis.

Footnotes

  • Ethics approval was not required by the authors’ institutions for case reports. The patient’s written informed consent was obtained.

REFERENCES

  1. 1.↵
    1. Marten K,
    2. Schnyder P,
    3. Schirg E,
    4. Prokop M,
    5. Rummeny EJ,
    6. Engelke C
    . Pattern-based differential diagnosis in pulmonary vasculitis using volumetric CT. AJR Am J of Roentgenol 2005;184:720–33.
    OpenUrl
  2. 2.↵
    1. Mielniczuk L,
    2. DeKemp RA,
    3. Dennie C,
    4. Yoshinaga K,
    5. Burwash IG,
    6. Bénard F,
    7. et al.
    Images in cardiovascular medicine. Fluorine-18-labeled deoxyglucose positron emission tomography in the diagnosis and management of aortitis with pulmonary artery involvement. Circulation 2005;111:e375–6.
    OpenUrlFREE Full Text
  3. 3.↵
    1. Muratore F,
    2. Kermani TA,
    3. Crowson CS,
    4. Green AB,
    5. Salvarani C,
    6. Matteson EL,
    7. et al.
    Large-vessel giant cell arteritis: a cohort study. Rheumatology 2015;54:463–70.
    OpenUrlCrossRefPubMed
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Cardiac and Pulmonary Artery Involvement Detected by 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Large-vessel Giant Cell Arteritis
RAFFAELLA UGOLINI, FRANCESCO MURATORE, CARLO SALVARANI
The Journal of Rheumatology Nov 2018, 45 (11) 1603-1604; DOI: 10.3899/jrheum.180061

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Cardiac and Pulmonary Artery Involvement Detected by 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Large-vessel Giant Cell Arteritis
RAFFAELLA UGOLINI, FRANCESCO MURATORE, CARLO SALVARANI
The Journal of Rheumatology Nov 2018, 45 (11) 1603-1604; DOI: 10.3899/jrheum.180061
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