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Unusual Presentation of Hurthle Cell Carcinoma With TENIS Syndrome as Left Atrial Thrombus on 18F-FDG PET/CT

Sood, Apurva, MD*; Parihar, Ashwin Singh, MBBS*; Sood, Ashwani, DNB*; Kumar, Rajender, MD*; Prakash, Gaurav, DM; Singhal, Manphool, MD; Gulati, Ajay, MD; Mittal, Bhagwant Rai, MD, DNB*; Bahl, Ajay, DM§; Singh, Shashank, DNB*

doi: 10.1097/RLU.0000000000002224
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Differentiated thyroid cancer (DTC) with thyroglobulin elevation and negative 131I scintigraphy (TENIS) syndrome is a diagnostic and therapeutic dilemma. Treatment of differentiated thyroid cancer has an excellent outcome, but treatment options in TENIS are limited with the exception of surgically amenable disease. We present a case of TENIS syndrome with incidental detection of tumor thrombus in right pulmonary vein extending to the left atrium on 18F-FDG PET/CT and subsequently complicating as an occipital bleed. The timely detection of the thrombus facilitated early initiation of anticoagulant therapy. However, the intracranial bleed precluded the continuation of anticoagulant therapy.

From the Departments of *Nuclear Medicine,

Internal Medicine,

Radiodiagnosis, and

§Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Received for publication March 26, 2018; revision accepted June 22, 2018.

Conflicts of interest and sources of funding: none declared.

Correspondence to: Ashwani Sood, DNB, Department of Nuclear Medicine, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh-160012, India. E-mail: sood99@yahoo.com.

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