Abnormal FDG PET Imaging in Tuberculosis Appearing Like Mesothelioma

Abstract

Fluoro-deoxy-glucose/positron emission tomography (FDG PET/CT) imaging has an established role in the evaluation of many malignancies. However, FDG also can be accumulated intensely by inflammatory lesions. We report a case of a 75-year-old man with recent fever and chronic cough for years. Chest radiograph showed multiple nodules in bilateral lung fields and pleural effusion on the left side, suspicious for lung metastases. Whole body FDG PET/CT scan demonstrated diffusely intense FDG uptake in the left thickened pleura and multiple focal areas of intense FDG uptake scattered in bilateral lungs. FDG PET/CT images in conjunction with anatomic delineation of coregistration CT were suspicious for active pulmonary tuberculosis with left tuberculous pleuritis, although the distribution of abnormal FDG uptake mimicked malignant pleural mesothelioma with lung metastases. Pulmonary tuberculosis was subsequently confirmed by sono-guided needle biopsy of the left pleura and sputum culture. In this case, anatomic features provided by CT can help for image interpretation.