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CC BY 4.0 · World J Nucl Med
DOI: 10.1055/s-0045-1812308
Case Report

Unilateral Brown Fat FDG Uptake after Childhood Sympathectomy Mimicking Malignancy Resolved by Hybrid PET/MR Image Fusion

Authors

  • Freimut Dankwart Eberhard Juengling 

    1   Department of Oncology, University of Alberta, Edmonton, Alberta, Canada

  • Judith Hafer 

    2   Department of Oncology, University Hospital of Basel, Basel, Kanton Basel-Stadt, Basel-Stadt, Switzerland

  • Alin Chirindel

    3   Department of Nuclear Medicine, University of Basel, Kanton Basel-Stadt, Basel-Stadt, Basel, Switzerland
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Abstract

Physiologic 18F-fluorodeoxyglucose (FDG) uptake in brown adipose tissue (BAT) is a recognized source of false-positive findings on positron emission tomography (PET) scans, typically presenting as symmetric, multifocal activity in fat-density tissue. We report a case of a 30-year-old woman with left-sided cervical swelling and unilateral, left-sided FDG uptake mimicking malignancy, but without corresponding computed tomography abnormalities. The patient's history included right-sided mediastinal ganglioneuroma resection in childhood, resulting in Horner syndrome. Hybrid PET/magnetic resonance (MR) imaging with image fusion definitively localized the FDG activity to left-sided BAT, confirming the tissue origin and linking the unilaterality to sympathetic denervation from prior right stellate ganglion disruption. This case illustrates that hybrid PET/MR can resolve diagnostic uncertainty in atypical BAT presentations and highlights the importance of recognizing altered BAT metabolism after sympathetic injury to avoid misinterpretation of PET findings.

Keywords

brown adipose tissue - Horner syndrome - magnetic resonance imaging - PET/MRI - positron emission tomography - stellate ganglion - sympathectomy


Publication History

Article published online:
24 October 2025

© 2025. 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/)

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