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F-18 FDG PET/CT Findings in A Case of T-Cell Lymphoma-Associated Hemophagocytic Syndrome With Liver Involvement

Suga, Kazuyoshi, MD*; Kawakami, Yasuhiko, MD*; Hiyama, Atsuto, MD*; Matsunaga, Naofumi, MD; Imoto, Shinobu, MD; Fukuda, Naofumi, MD; Miyazaki, Mutsuko, MD

doi: 10.1097/RLU.0b013e3181c7bf20
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This is a report of fluoro-deoxy-glucose positron emission tomography/computed tomography (F-18-FDG PET/CT) findings in a case of T-cell lymphoma-associated hemophagocytic syndrome, with “periportal low attenuation” and edematous gall-bladder wall thickening. FDG PET/CT showed diffuse intense FDG uptake in the enlarged liver and spleen, with systemic FDG-avid lymphadenopathy including the hepatic hilar nodes. Fused plain CT and subsequent contrast-enhanced CT showed no hepatic parenchymal architectural abnormality but periportal low attenuation and edematous gallbladder wall thickening without FDG uptake. The second FDG PET/CT at 6 months after chemoimmunotherapy showed disappearance of the systemic abnormal FDG uptake including the enlarged hepatic hilar nodes and periportal/gall bladder abnormalities, with improvement of hepatosplenomegaly and laboratory data. This case suggests that FDG PET/CT is useful for detecting hepatic involvement of lymphoma and secondary-activated histiocytes causing a hemophagocytic syndrome, and that periportal low attenuation and an edematous gallbladder wall can be an indirect sign of lymphatic obstruction caused by FDG-avid hepatic hilar lymphadenopathy.

From the *Department of Radiology, St. Hill Hospital, Yamaguchi, Japan; †Department of Radiology, Yamaguchi University School of Medicine, Yamaguchi, Japan; and ‡Department of Hematology, Ube-Kousan Central Hospital, Ube, Japan.

Received for publication January 13, 2009; accepted May 26, 2009.

Disclosure of funding was not received for this work from any of the following organizations: National Institutes of Health (NIH); Wellcome Trust; Howard Hughes Medical Institute (HHMI); and other(s).

Reprints: Kazuyoshi Suga, MD, Department of Radiology, St. Hill Hospital, 1462–3 Nishikiwa, Ube, Yamaguchi 755-0151, Japan. E-mail:

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