PET-CT case of the month (07/09): PET-CT in Pulmonary Tuberculosis
This case was compiled by Dr. Niraj R. Patel, BCM
A 58 year old caucasian male, nonsmoker, with h/o hypertension and gout presents with
shortness of breath. He has lost 20 lbs of weight in the last 2 yrs which he attributes to life
stressors and poor appetite and endorses having had long-term asbestos exposure.
Chest Xray showed bilateral non-specific nodular lesions and pleural effusion. CT scan of
the chest showed bilateral pulmonary nodules suggestive of metastatic cancer or infection,
right lower lobe mass, bilateral pleural effusion, worse on the right, and a large hypodense
soft tissue mass in the lower abdomen. No evidence of mediastinal or hilar adenopathy.
shortness of breath. He has lost 20 lbs of weight in the last 2 yrs which he attributes to life
stressors and poor appetite and endorses having had long-term asbestos exposure.
Chest Xray showed bilateral non-specific nodular lesions and pleural effusion. CT scan of
the chest showed bilateral pulmonary nodules suggestive of metastatic cancer or infection,
right lower lobe mass, bilateral pleural effusion, worse on the right, and a large hypodense
soft tissue mass in the lower abdomen. No evidence of mediastinal or hilar adenopathy.
The transbronchial biopsy was positive for chronic inflammation and AFB. A sputum
sample was sent for culture and showed pan-sensitive TB. Patient was started on Directly
Observed Therapy (4 drugs – for 9 months). Follow-up CT showed no change in the original
pulmonary nodules, decrease in size of the right lower lobe mass and slight decrease in the
pleural effusion. Patient improved clinically.
Follow up PET/CT showed significantly decreased FDG activity in the lung lesions, along
with a generalized decrease in size, suggesting a good response of pulmonary TB to the 4-
drug therapy.
sample was sent for culture and showed pan-sensitive TB. Patient was started on Directly
Observed Therapy (4 drugs – for 9 months). Follow-up CT showed no change in the original
pulmonary nodules, decrease in size of the right lower lobe mass and slight decrease in the
pleural effusion. Patient improved clinically.
Follow up PET/CT showed significantly decreased FDG activity in the lung lesions, along
with a generalized decrease in size, suggesting a good response of pulmonary TB to the 4-
drug therapy.
1. Evaluation of therapeutic response of tuberculoma using F-18 FDG positron emission
tomography. Park IN, Ryu JS, Shim TS. Clin Nucl Med. 2008 Jan;33(1):1-3
2. Usefulness of 18F-fluorodeoxyglucose positron emission tomography for diagnosing
disease activity and monitoring therapeutic response in patients with pulmonary
mycobacteriosis. Demura Y, Tsuchida T, Uesaka D, Umeda Y, Morikawa M, Ameshima S,
Ishizaki T, Fujibayashi Y, Okazawa H. Eur J Nucl Med Mol Imaging. 2009 Apr;36(4):632-9
tomography. Park IN, Ryu JS, Shim TS. Clin Nucl Med. 2008 Jan;33(1):1-3
2. Usefulness of 18F-fluorodeoxyglucose positron emission tomography for diagnosing
disease activity and monitoring therapeutic response in patients with pulmonary
mycobacteriosis. Demura Y, Tsuchida T, Uesaka D, Umeda Y, Morikawa M, Ameshima S,
Ishizaki T, Fujibayashi Y, Okazawa H. Eur J Nucl Med Mol Imaging. 2009 Apr;36(4):632-9
