key: cord-0688449-otq934qo authors: Alonso Sanchez, Jaime; García Prieto, Julia; Galiana Morón, Alvaro; Pilkington-Woll, John Patrick title: PET/CT of COVID-19 as an Organizing Pneumonia date: 2020-06-08 journal: Clin Nucl Med DOI: 10.1097/rlu.0000000000003174 sha: 3ace72f7f1549d173a9d4294eafb8678f7a892a5 doc_id: 688449 cord_uid: otq934qo An 85-year-old woman with history of melanoma is referred for a follow-up (18)F-FDG PET/CT. (18)F-FDG PET/CT scan showed bilateral and peripheral ground-glass opacities in upper and lower pulmonary lobes surrounded by consolidations of crescent shape with increased FDG uptake, findings compatible with organizing pneumonia. Following further inquiry, the patient reported low-grade fever, sore throat, and fatigue for the past 6 days. Because of the ongoing COVID-19 pandemic, the patient was tested for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), which resulted positive. FIGURE 1. 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. 18 F-FDG PET/CT showed increased FDG uptake (B). 18 F-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 18 F-FDG PET/CT findings include avid lung parenchyma and mediastinal node FDG uptake, reflecting a significant inflammatory response. [8] [9] [10] [11] Although 18 F-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] [13] [14] [15] Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study Clinical characteristics of coronavirus disease 2019 in China Coronavirus disease 2019 (COVID-19): role of chest CT in diagnosis and management Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study Radiology perspective of coronavirus disease 2019 (COVID-19): lessons from severe acute respiratory syndrome and Middle East respiratory syndrome Incidental CT findings suspicious for COVID-19 associated pneumonia on nuclear medicine exams: recognition and management plan FDG PET/CT of COVID-19 18 F-FDG PET/CT findings of COVID-19: a series of four highly suspected cases The potential added value of FDG PET/CT for COVID-19 pneumonia 18 F-FDG PET/CT and serial chest CT findings in a COVID-19 patient with dynamic clinical characteristics in different period Incidental findings suggestive of COVID-19 in asymptomatic patients undergoing nuclear medicine procedures in a high-prevalence region COVID-19: guidance for infection prevention and control in nuclear medicine COVID19-nuclear medicine departments, be prepared Emerging attack and management strategies for nuclear medicine in responding to COVID-19-ACNM member experience and advice