Infrarenal atheromatous plaque with ulceration (PET-CT)

Case contributed by Jenna Saxton

Presentation

A patient with a past medical history of adenocarcinoma of the gastroesophageal junction who recently underwent a craniotomy, resection, and radiosurgery for brain metastasis. She was re-evaluated with a surveillance PET/CT.

Patient Data

Age: 55 years
Gender: Female
CT

CT with contrast

Hypodense atheromatous plaque is noted within an area of focal dilation in the infrarenal abdominal aorta.

Hypodense atheromatous plaque is noted within an area of focal dilation in the infrarenal abdominal aorta. This is crescentic and eccentric to the left on axial imaging and longitudinally extensive on coronal reconstruction (red arrows). 

Nuclear medicine

PET-CT

A mild, crescentic area showing metabolic activity within an infrarenal aortic aneurysm. 

A mild, crescentic area showing metabolic activity within an infrarenal aortic aneurysm. This most likely is related to an ulcerated atheroma (blue arrow). 

Case Discussion

On PET-CT there was no suspicious metabolic activity nor enlarged adenopathy to suggest recurrence of her malignancy. However, there was a mildly increased crescent-shaped focal metabolic activity note on the left side in a focally dilated portion of the infrarenal aorta. This metabolic activity suggests inflammation and a degree of instability, most likely correlating with an atheromatous plaque seen on a previous contrast CT. 

The patient was referred to vascular surgery for further evaluation. Due to her asymptomatic presentation, the small size of the aneurysm, and unremarkable peripheral vascular exam, she opted for expectant management with a one year follow up with aortic duplex ultrasound. 

Learning points:

  • PET-CT allows for early, noninvasive detection of atherosclerotic disease 1 
  • FDG is the most common PET tracer used and its uptake by plaque macrophages is well established 2
  • coronary artery imaging, however, is limited due to FDG accumulation in all cells that metabolize glucose and background myocardial uptake is generally greater than a plaque specific signal 2

Additional Contributor: Dr. Leanne Lin

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Case information

rID: 70780
Published: 6th Sep 2019
Last edited: 7th Sep 2019
System: Vascular
Inclusion in quiz mode: Included

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