Secondary Logo

Journal Logo

Interesting Images

PET/CT of COVID-19 as an Organizing Pneumonia

Alonso Sanchez, Jaime MD; García Prieto, Julia MD; Galiana Morón, Alvaro MD; Pilkington-Woll, John Patrick MD

Author Information
doi: 10.1097/RLU.0000000000003174
  • Free


A, Chest CT scan. B, PET. We report the case of an 85-year-old woman with history of melanoma referred for FDG PET/CT. The PET/CT showed bilateral and peripheral ground-glass opacities with areas of focal consolidation primarily in left upper lobe (A, black arrow) and crescent-shaped consolidations in right and left lower lobes (A, white arrows). These findings are also known as reversed halo sign. 18F-FDG PET/CT showed increased FDG uptake (B). 18F-FDG PET/CT findings are compatible with an organizing pneumonia pattern suggestive of an infectious or inflammatory etiology. Following further inquiry, the patient reported history of low-grade fever, fatigue, and sore throat for the past 6 days. The patient was referred to the emergency department where, after careful review of the symptoms, she underwent a reverse transcriptase–polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which tested positive. She was admitted to the hospital and discharged 5 days later with complete resolution of the initial symptoms after treatment. COVID-19 is a disease caused by SARS-CoV-2, a new coronavirus that was first reported in China. Cough and fever are the most common symptoms, but the disease could be fatal in patients with multiple comorbidities.1,2 The diagnosis of COVID-19 could be challenging because symptoms can overlap with other diseases such as influenza, adenovirus, Middle East respiratory syndrome, or SARS.3 CT scan is a very sensitive tool in initial stages of the disease,4 and findings often consist in unilateral or bilateral ground-glass opacities (often rounded morphology) with or without consolidation in early phases. As time passes, superimposed consolidations over previous ground-glass opacities are the most frequent pattern with septal thickening, bronchiectasis, pleural thickening, and effusion.5–7 18F-FDG PET/CT findings include avid lung parenchyma and mediastinal node FDG uptake, reflecting a significant inflammatory response.8–11 Although 18F-FDG PET/CT is not routinely indicated for inflammatory disease, COVID-19 may be found incidentally,10 and nuclear medicine professionals must be aware of the typical findings.12–15


1. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507–513.
    2. Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708–1720.
      3. Li Y, Xia L. Coronavirus disease 2019 (COVID-19): role of chest CT in diagnosis and management. AJR Am J Roentgenol. 2020;1–7.
        4. Ai T, Yang Z, Hou H, et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology. 2020;200642.
          5. Shi H, Han X, Jiang N, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis. 2020;20:425–434.
            6. Hosseiny M, Kooraki S, Gholamrezanezhad A, et al. Radiology perspective of coronavirus disease 2019 (COVID-19): lessons from severe acute respiratory syndrome and Middle East respiratory syndrome. AJR Am J Roentgenol. 2020;214:1078–1082.
              7. Tulchinsky M, Fotos JS, Slonimsky E. Incidental CT findings suspicious for COVID-19 associated pneumonia on nuclear medicine exams: recognition and management plan. Clin Nucl Med. 2020.
                8. Zou S, Zhu X. FDG PET/CT of COVID-19. Radiology. 2020;200770.
                  9. Qin C, Liu F, Yen TC, et al. 18F-FDG PET/CT findings of COVID-19: a series of four highly suspected cases. Eur J Nucl Med Mol Imaging. 2020;47:1281–1286.
                    10. Deng Y, Lei L, Chen Y, et al. The potential added value of FDG PET/CT for COVID-19 pneumonia. Eur J Nucl Med Mol Imaging. 2020.
                      11. Liu C, Zhou J, Xia L, et al. 18F-FDG PET/CT and serial chest CT findings in a COVID-19 patient with dynamic clinical characteristics in different period. Clin Nucl Med. 2020;45:495–496.
                        12. Albano D, Bertagna F, Bertoli M, et al. Incidental findings suggestive of COVID-19 in asymptomatic patients undergoing nuclear medicine procedures in a high-prevalence region. J Nucl Med. 2020;61:632–636.
                          13. Buscombe JR, Notghi A, Croasdale J, et al. COVID-19: guidance for infection prevention and control in nuclear medicine. Nucl Med Commun. 2020;41:499–504.
                            14. Huang HL, Allie R, Gnanasegaran G, et al. COVID19—nuclear medicine departments, be prepared! Nucl Med Commun. 2020;41:297–299.
                              15. Lu Y, Zhu X, Yan SX, et al. Emerging attack and management strategies for nuclear medicine in responding to COVID-19-ACNM member experience and advice. Clin Nucl Med. 2020.

                                coronavirus infection; PET/CT scan; pneumonia

                                Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.