Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Hodgkin's Lymphoma: Diagnostic Challenge during COVID Vaccination

Sharjeel Usmani 1, Fatma Al-Ramadhan 2, Fareeda Al-Kandari 2, Najeeb Ahmed 3

Affiliations

01 July 2021

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doi: 10.4103/ijnm.ijnm_31_21

Abstract

Benign metabolic uptake on fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET) is not uncommonly seen after immunization. We report a case of 30-year-old man with Hodgkin's lymphoma who underwent two cycles of chemotherapy. Interim 18F-FDG PET/computed tomography demonstrated complete metabolic response of prior hypermetabolic bilateral supraclavicular and mediastinal lymph nodes. Although multiple new normal-sized hypermetabolic left axillary and subpectoral lymph nodes are noted, relevant history revealed COVID vaccine 7 days prior scan with mild FDG uptake at the left deltoid muscle. These new findings at the left axilla are likely related to recent vaccination. 18F-FDG PET uptake in the lymph nodes is not so uncommon after immunization; relevant history is very important especially in the phase of massive immunization to avoid false interpretation.

Keywords: COVID-19; Fluorine-18 fluorodeoxyglucose positron emission tomography; vaccination.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1 a) Baseline 18F-FDG PET MIP image and b-c) Transaxial PET/CT images show multiple hypermetabolic lymph nodes at bilateral supraclavicular and anterior mediastinal regions

Figure 1 a) Baseline 18F-FDG PET MIP image and b-c) Transaxial PET/CT images show multiple hypermetabolic lymph nodes at bilateral supraclavicular and anterior mediastinal regions

Figure 2 a) Interim 18F-FDG PET MIP image demonstrate complete metabolic response of prior hypermetabolic bilateral supraclavicular and mediastinal lymph nodes. Although multiple new hypermetabolic left axillary and subpectoral lymph nodes are noted. Non-contrast CT images show normal lymph nodes (c,d). Relevant history revealed COVID vaccine 7 days prior scan with mild FDG uptake at left deltoid muscle (b). These new findings at left axilla are likely related to recent vaccination

Figure 2 a) Interim 18F-FDG PET MIP image demonstrate complete metabolic response of prior hypermetabolic bilateral supraclavicular and mediastinal lymph nodes. Although multiple new hypermetabolic left axillary and subpectoral lymph nodes are noted. Non-contrast CT images show normal lymph nodes (c,d). Relevant history revealed COVID vaccine 7 days prior scan with mild FDG uptake at left deltoid muscle (b). These new findings at left axilla are likely related to recent vaccination

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