We describe a case in which fludeoxyglucose F 18 positron emission tomography (PET) led directly to the diagnosis of giant cell arteritis in an elderly woman with a fever of unknown origin.The patient presented with a 3-month history of fatigue, fever, headache, visual disturbance, jaw claudication, and anemia. A computed tomographic scan showed an anterior mediastinal mass that was suspected of being malignant. A fludeoxyglucose F 18 PET scan performed for preoperative evaluation identified striking uptake of fludeoxyglucose F 18 in the walls of the entire aorta, left main coronary artery, and subclavian, carotid, and common iliac arteries bilaterally, suggestive of an arteritis, a diagnosis subsequently confirmed by the findings of an arterial biopsy. Her erythrocyte sedimentation rate was 129 mm/h. There was normalizaton of the PET scan 2 weeks following treatment with prednisolone. This case suggests that fludeoxyglucose F 18 PET contributes to the noninvasive diagnosis of giant cell arteritis, as well as to the evaluation of the extent of disease, response to therapy, and disease recurrence.
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Noncontrast computed tomographic scan demonstrating anterior mediastinal mass (arrow) found to be an enlarged thymus on biopsy.
Fludeoxyglucose F 18 positron emission tomography 3-dimensional volume-rendered image, frontal (A) and oblique (B) projections.
A, Muscular artery (right) with associated giant cell reaction (arrow) and adjacent vein (left) (hematoxylin-eosin, original magnification ×50). B, High-power view of the same multinucleated giant cell (hematoxylin-eosin, original magnification ×200).
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