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Reactivation of appendicectomy scar in sarcoidosis detected by FDG-PET
Indian Journal of Rheumatology 2012 September Volume 7, Number 3; pp. 169e170
Images in Rheumatology
Reactivation of appendicectomy scar in sarcoidosis detected by FDG-PET Krishnan Shanmuganandana, Darshan S. Bhakunib, Sivasami Kartikc,*
ABSTRACT Sarcoidosis is a multisystem disorder of unknown etiology with protean manifestations. We herewith present a FDGPET image of reactivation of appendicectomy scar in a patient with newly diagnosed Sarcoidosis. Copyright © 2012, Indian Rheumatology Association. All rights reserved.
45-year old lady presented with bilateral ankle arthritis, fever and 6 kg weight loss of 1-month duration. Evaluation revealed raised acute phase reactants, bilateral hilar
lymphadenopathy, revealed FDG avid (SUV max 6.0) subcutaneous lesion located in the right iliac lesion (Fig. 1a and b) corresponding to appendicectomy scar. On direct enquiry
Fig. 1 a & b: FDG-PET scan coronal and transverse cuts showing FDG avid uptake in appendicectomy scar (arrows).
and subcarinal lymphadenopathy, raised serum Angiotensin converting enzyme (ACE) levels. Based on this she was diagnosed as a case of sarcoidosis. FDG-PET was done which in addition to hilar and subcarinal
patient admitted to increased darkening and thickening of the scar since the onset of her present illness. Sarcoidosis is a chronic granulomatous inflammation of unknown aetiology characterised by multisystem organ infiltration
a Professor, bProfessor and Head, cSenior Resident (Rheumatology), Department of Rheumatology, Army Hospital (Research & Referral), New Delhi 10010, India. * Corresponding author. Tel.: þ91 23338167, email: [email protected] Available online: 20.7.2012 Copyright Ó 2012, Indian Rheumatology Association. All rights reserved.
http://dx.doi.org/10.1016/j.injr.2012.07.007
170
Indian Journal of Rheumatology 2012 September; Vol. 7, No. 3
and varied clinical presentation.1 Surgical scars may get infiltrated with sarcoid granulomas and cause tenderness, induration and hyperpigmentation of the scars. These lesions can occur early in course of the disease or parallel reactivation of sarcoidosis.2 FDG-PET is being increasingly used as a tool to determine the extent of organ involvement and to identify any residual illness in sarcoidosis.3
CONFLICTS OF INTEREST All authors have none to declare.
Shanmuganandan et al.
REFERENCES 1. Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med. 2007;357:2153e2165. 2. Hunningahke GW, Costabel U, Ando M, et al. ATS/ERS/ WASOG statement on sarcoidosis. American Thoracic Society/European Respiratory Society/World association of Sarcoidosis and other Granulomatous Disorders. Sarcoidosis Vasc Diffuse Lung Dis. 1999;16:149e1733. 3. Teirstein AS, Machac J, Almeida O, et al. Results of 188 whole-body fluorodeoxyglucose positron emission tomography scans in 137 patients with sarcoidosis. Chest. 2007;132:1949.
Images in Rheumatology
Reactivation of appendicectomy scar in sarcoidosis detected by FDG-PET Krishnan Shanmuganandana, Darshan S. Bhakunib, Sivasami Kartikc,*
ABSTRACT Sarcoidosis is a multisystem disorder of unknown etiology with protean manifestations. We herewith present a FDGPET image of reactivation of appendicectomy scar in a patient with newly diagnosed Sarcoidosis. Copyright © 2012, Indian Rheumatology Association. All rights reserved.
45-year old lady presented with bilateral ankle arthritis, fever and 6 kg weight loss of 1-month duration. Evaluation revealed raised acute phase reactants, bilateral hilar
lymphadenopathy, revealed FDG avid (SUV max 6.0) subcutaneous lesion located in the right iliac lesion (Fig. 1a and b) corresponding to appendicectomy scar. On direct enquiry
Fig. 1 a & b: FDG-PET scan coronal and transverse cuts showing FDG avid uptake in appendicectomy scar (arrows).
and subcarinal lymphadenopathy, raised serum Angiotensin converting enzyme (ACE) levels. Based on this she was diagnosed as a case of sarcoidosis. FDG-PET was done which in addition to hilar and subcarinal
patient admitted to increased darkening and thickening of the scar since the onset of her present illness. Sarcoidosis is a chronic granulomatous inflammation of unknown aetiology characterised by multisystem organ infiltration
a Professor, bProfessor and Head, cSenior Resident (Rheumatology), Department of Rheumatology, Army Hospital (Research & Referral), New Delhi 10010, India. * Corresponding author. Tel.: þ91 23338167, email: [email protected] Available online: 20.7.2012 Copyright Ó 2012, Indian Rheumatology Association. All rights reserved.
http://dx.doi.org/10.1016/j.injr.2012.07.007
170
Indian Journal of Rheumatology 2012 September; Vol. 7, No. 3
and varied clinical presentation.1 Surgical scars may get infiltrated with sarcoid granulomas and cause tenderness, induration and hyperpigmentation of the scars. These lesions can occur early in course of the disease or parallel reactivation of sarcoidosis.2 FDG-PET is being increasingly used as a tool to determine the extent of organ involvement and to identify any residual illness in sarcoidosis.3
CONFLICTS OF INTEREST All authors have none to declare.
Shanmuganandan et al.
REFERENCES 1. Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med. 2007;357:2153e2165. 2. Hunningahke GW, Costabel U, Ando M, et al. ATS/ERS/ WASOG statement on sarcoidosis. American Thoracic Society/European Respiratory Society/World association of Sarcoidosis and other Granulomatous Disorders. Sarcoidosis Vasc Diffuse Lung Dis. 1999;16:149e1733. 3. Teirstein AS, Machac J, Almeida O, et al. Results of 188 whole-body fluorodeoxyglucose positron emission tomography scans in 137 patients with sarcoidosis. Chest. 2007;132:1949.