Subscribe to RSS
DOI: 10.1055/s-0044-1779284
18F-Fluorodeoxyglucose Uptake in Bilateral Diaphragmatic Crura: A Relatively Uncommon Benign Variant Noted in a Treated Case of Extraosseous Paraspinal Ewing's Sarcoma
Funding None.Abstract
A toddler was diagnosed with extraosseous Ewing's sarcoma, primary large epidural paraspinal soft tissue in the lumbar region encasing the cord and neural foramen from D12–L1 to L4–L5. After eight cycles of induction chemotherapy with vincristine, doxorubicin, and cyclophosphamide alternating with etoposide and ifosfamide, 18F-FDG positron emission tomography/computed tomography (18F-FDG-PET/CT) scan confirmed no active disease. Later external beam radiotherapy (EBRT) at D10–L5 was completed. At 3 months follow-up, 18F-FDG-PET/CT reconfirmed no residual/active disease; however, a new incidental finding of diffuse benign bilateral diaphragmatic 18F-FDG uptake was noted in the clinically asymptomatic patient, which remained unexplained.
Keywords
extraosseous paraspinal Ewing's sarcoma - bilateral diaphragmatic crura - FDG-PET/CT - benign variant - nonspecific FDG uptakePublication History
Article published online:
06 February 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Kaspers GJ, Kamphorst W, van de Graaff M, van Alphen HA, Veerman AJ. Primary spinal epidural extraosseous Ewing's sarcoma. Cancer 1991; 68 (03) 648-654
- 2 Isefuku S, Seki M, Tajino T. et al. Ewing's sarcoma in the spinal nerve root: a case report and review of the literature. Tohoku J Exp Med 2006; 209 (04) 369-377
- 3 Cuaron J, Dunphy M, Rimner A. Role of FDG-PET scans in staging, response assessment, and follow-up care for non-small cell lung cancer. Front Oncol 2013; 2: 208
- 4 Jadvar H, Colletti PM, Delgado-Bolton R. et al. Appropriate use criteria for 18F-FDG PET/CT in restaging and treatment response assessment of malignant disease. J Nucl Med 2017; 58 (12) 2026-2037
- 5 Ulaner GA, Lyall A. Identifying and distinguishing treatment effects and complications from malignancy at FDG PET/CT. Radiographics 2013; 33 (06) 1817-1834
- 6 Jolepalem P, Hwang JY, Wong CY. Radiation therapy-induced phrenic neuropathy mimicking metastasis to the diaphragmatic crus on 18F-FDG PET/CT. J Nucl Med Technol 2014; 42 (01) 68-69
- 7 De Vito EL, Quadrelli SA, Montiel GC, Roncoroni AJ. Bilateral diaphragmatic paralysis after mediastinal radiotherapy. Respiration 1996; 63 (03) 187-190
- 8 Avila EK, Goenka A, Fontenla S. Bilateral phrenic nerve dysfunction: a late complication of mantle radiation. J Neurooncol 2011; 103 (02) 393-395
- 9 Ossowska K, Porazenie N. Paralysis of the phrenic nerve following irradiation therapy. Gruzlica 1975; 43 (06) 587-590
- 10 Joshi P, Lele V. Left is right and right is wrong: fluorodeoxyglucose uptake in left hemi-diaphragm due to right phrenic nerve palsy. Indian J Nucl Med 2013; 28 (01) 32-33
- 11 Chander S, Ergun EL, Zak IT. et al. Diaphragmatic and crural FDG uptake in hyperventilating patients: a rare pattern important to recognize. Clin Nucl Med 2004; 29 (05) 296-299
- 12 Joseph JK, Nair N, Basu S. Increased muscle 18F-FDG uptake in an agitated child. Hell J Nucl Med 2010; 13 (03) 282
- 13 Park YH, Baik JH, Ahn MI, Kim JY. FDG uptake in the diaphragm and crura, vocal cords, and base of tongue in a crying child. Clin Nucl Med 2005; 30 (11) 752-753