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Laboratory-Proven Asymptomatic SARS-CoV-2 (COVID-19) Infection on 18F-FDG PET/CT

Krebs, Simone MD; Petkovska, Iva MD; Ho, Alan L. MD, PhD†,‡; Ulaner, Gary A. MD, PhD∗,§

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doi: 10.1097/RLU.0000000000003141
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Abstract

FIGURE 1
FIGURE 1:
A 87-year-old man with primary salivary duct carcinoma and hepatic metastases was referred for restaging with 18F-FDG PET/CT. A, 18F-FDG PET maximum intensity projection of the body demonstrates multiple FDG-avid foci overlying the thorax (arrows), as well as an 18F-FDG–avid hepatic metastasis (curved arrow). Prominent but physiologic 18F-FDG avidity was also seen in the colon (arrowheads). Axial CT and 18F-FDG PET images at the level of upper lungs (B), aortic arch (C), and mainstem bronchi (D) demonstrate that the FDG avidity corresponds to multiple areas of ground-glass and patchy opacities with intralobular septal thickening in both lungs (arrows). Despite being asymptomatic for pneumonia, these imaging findings suggested COVID-19 infection. The patient tested positive for COVID-19 using real-time reverse transcription–polymerase chain reaction. COVID-19 is a pneumonia caused by the SARS-CoV-2 virus, first identified in China and now pandemic.1 SARS-CoV-2 infection may present with a broad array of findings, ranging for asymptotic infection, through upper and lower respiratory symptoms of varying severity, to death.2 The current criterion-standard diagnostic test for SARS-CoV-2 infection is real-time reverse transcription polymerase chain reaction (RT-PCR) test of viral RNA collected from upper respiratory tract samples. It has recently been reported that these molecular tests may yield false-negative results, and supplementary role of clinical data, including laboratory examination results and CT features, can be considered.3 The most common CT findings of COVID-19 pneumonia are ground-glass opacities and intralobular septal thickening with a peripheral dominant distribution, as seen in our patient. Consolidative opacities have correlated with more severe clinical symptoms, which were lacking in our asymptomatic patient.4–8 This case demonstrated that outpatient 18F-FDG PET/CT studies can identify radiologic signs of COVID-19 pneumonia, even in asymptomatic patients. Outpatients undergoing oncologic 18F-FDG PET/CT should be evaluated for radiologic findings suggestive of COVID-19 during this pandemic. Imaging findings leading to a positive COVID-19 laboratory test could lead to quarantine of a patient.

REFERENCES

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          Keywords:

          COVID-19; FDG PET/CT; ground-glass opacities; intralobular septal thickening; SARS-CoV-2 infection

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