Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
  Home Print this page Email this page Small font sizeDefault font sizeIncrease font size Users Online: 913  

 
   Table of Contents      
CASE REPORT
Year : 2015  |  Volume : 14  |  Issue : 1  |  Page : 66-67

Unusual Intense Fluorodeoxyglucose Uptake in the Intercostal Muscles Due to Severe Shortness of Breath in a Patient with Heart Failure


1 Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada
2 Department of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada

Date of Web Publication2-Feb-2015

Correspondence Address:
Masoud Shariat
Department of Medical Imaging, Toronto General Hospital, 585 University Avenue, Toronto, On M5G 2C4
Canada
Login to access the Email id


DOI: 10.4103/1450-1147.150561

PMID: 25709551

Rights and Permissions
   Abstract 

We present a case of unusually intense Fluorodeoxyglucose uptake in the intercostal muscles during a Fluorodeoxyglucose positron emission tomography (FDG-PET). We hypothesized that severe left ventricular failure causing the patient to be short of breath during the study in association with insulin injection as part of study protocol led to the intense uptake of FDG in the respiratory muscles causing such an unusual appearance.

Keywords: Positron emission tomography, skeletal muscle, viability study


How to cite this article:
Shariat M, Mohan R, Iwanochko MR. Unusual Intense Fluorodeoxyglucose Uptake in the Intercostal Muscles Due to Severe Shortness of Breath in a Patient with Heart Failure. World J Nucl Med 2015;14:66-7

How to cite this URL:
Shariat M, Mohan R, Iwanochko MR. Unusual Intense Fluorodeoxyglucose Uptake in the Intercostal Muscles Due to Severe Shortness of Breath in a Patient with Heart Failure. World J Nucl Med [serial online] 2015 [cited 2019 Dec 6];14:66-7. Available from: http://www.wjnm.org/text.asp?2015/14/1/66/150561


   Introduction Top


Skeletal muscle uptake has been previously described on fluorodeoxyglucose positron emission tomography (FDG-PET). [1] It has also been documented that patients with shortness of breath and labored breathing can have increased uptake in the respiratory muscles. [2] Benign skeletal muscle uptake usually has a symmetric pattern and follows the anatomy of the muscular group and no corresponding lesion can be seen on the integrated computed tomography (CT) study. [1]


   Case Report Top


A 65-year-old female with left ventricular failure (ejection fraction of 20-29% on echocardiography) was referred for FDG-PET study to assess myocardial viability. The viability study protocol included fasting for 8 h followed by 25-50 g of oral glucose and 1-2 units of intravenous insulin injection prior to the study. The oral glucose dose was determined by the fasting blood sugar level and the insulin dose was determined by blood sugar level taken 1 h after the oral glucose was given. The patient was reported to be extremely short of breath during the study. Study was performed using a single 10 min static acquisition on a PET/CT scanner (Siemens Biograph mCT, Siemens Healthcare, Germany). A total FDG dose of 495.0 MBq was given. The viability study showed viable myocardium in the apex and distal interventricular septum. There was additional finding of unusually intense, bilateral and symmetrical intercostal muscle uptake giving the picture of two demonic hands on either side of the patient's thorax [Figure 1],[Figure 2],[Figure 3] and [Figure 4] and [Video 1].
Figure 1: Maximum intensity projection views show intense fluorodeoxyglucose uptake in intercostal muscles creating a picture of two demonic hands on either side of the patient's chest

Click here to view
Figure 2: Axial and sagittal images show fluorodeoxyglucose uptake in intercostal muscles

Click here to view
Figure 3: Sagittal positron emission tomography computed tomography fusion images

Click here to view
Figure 4: Short and long axes reconstruction images show fluorodeoxyglucose uptake in the intercostal muscles

Click here to view






   Discussion Top


Focal skeletal muscle uptake although well described may still pose a diagnostic dilemma. Such intense intercostal muscle uptake and the resultant peculiar picture are unusual. We hypothesized that severe left ventricular failure causing the patient to be severely short of breath in association with the study protocol, which included injection of insulin have both led to the intense uptake of FDG in the respiratory muscles causing such an unusual appearance.

 
   References Top

1.
Liu Y, Ghesani NV, Zuckier LS. Physiology and pathophysiology of incidental findings detected on FDG-PET scintigraphy. Semin Nucl Med 2010;40:294-315.  Back to cited text no. 1
    
2.
Bural GG, Mavi A, Kumar R, Alavi A. FDG uptake in intercostal muscles is an indicator of severe respiratory disease. Clin Nucl Med 2004;29:807-8.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


This article has been cited by
1 Adenocarcinoma of the Stomach Leading to Recurrent Regurgitation and Muscular Hypermetabolism on 18F-FDG PET/CT
Ashwin Singh Parihar,Shelvin Kumar Vadi,Rajender Kumar,Bhagwant Rai Mittal,Harmandeep Singh,Rakesh Kapoor
Clinical Nuclear Medicine. 2019; 44(11): 901
[Pubmed] | [DOI]
2 Intense FDG Uptake in the Muscles Due to Severe Vomiting
Jie Liu,Wei Wang,Leilei Yuan,Ying Kan,Jigang Yang
Clinical Nuclear Medicine. 2018; : 1
[Pubmed] | [DOI]
3 Increased Skeletal Muscle FDG Uptake Due to Sexual Activity on PET/CT in a Middle Age Woman
Wei Wang,Ying Kan,Jie Liu,Leilei Yuan,Jigang Yang
Clinical Nuclear Medicine. 2018; : 1
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Case Report
   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed1129    
    Printed37    
    Emailed0    
    PDF Downloaded122    
    Comments [Add]    
    Cited by others 3    

Recommend this journal