key: cord-0756172-4gizoj8r
authors: Salvat Dávila, Carmen; Suárez Fernández, Juan Pablo; Domínguez Grande, María Luz; Vigil Díaz, Carmen; Fernández Llana, Belén; Martín Fernández, Noelia; González García, Francisco Javier
title: SARS-CoV-2 (COVID-19) pneumonia: Incidental finding on (18)F-FDG PET/CT study for vasculitis diagnosis()
date: 2020-12-04
journal: Rev Esp Med Nucl Imagen Mol (Engl Ed)
DOI: 10.1016/j.remnie.2020.08.004
sha: fb55031d3f53ac8a0de012d196a977fb4b7e9eb4
doc_id: 756172
cord_uid: 4gizoj8r

nan

A 69-year-old woman diagnosed of ischemic stroke of the basal ganglia and no respiratory symptoms had a blood test with leukocytosis with left shift, increased acute phase reactants, high levels of d-dimer and antithrombin III deficiency. Cranial magnetic resonance imaging was consistent with cerebral vasculitis and a computed tomography angiography showed narrowing of the left subclavian artery. Due to the clinical suspicion of a systemic vasculitis, a 18 F-FDG PET/CT study was performed, showing a diffuse increased glucose metabolism in the wall of main arterial vessels, suggesting a large vessel vasculitis (Fig. 1) . As an incidental finding, bilateral multifocal lung lesions were detected, especially in the lower lobes, with ground glass opacifications and increased 18 F-FDG uptake, consistent with bronchopneumonia ( Fig. 2 and IgG anti-SARS-CoV-2 antibodies, with a positive result indicating active infection. The patient was isolated for two weeks and developed no symptoms during that period. Patients infected with coronavirus SARS-CoV-2 are usually asymptomatic or present unspecified symptoms, like fever, asthenia or dry cough. 1 The most serious clinical manifestation is viral pneumonia, often requiring hospitalization, or even ventilatory support on severe cases, like acute respiratory distress syndrome. 1 Chest X-ray is not recommended for the diagnosis of SARS-CoV-2 pneumonia due to its low sensibility in comparison with chest CT, which is the preferred imaging technique. The most frequent findings on CT are ground glass opacifications (72%), that can be bilateral in more than half of the cases, and sometimes associated with consolidations (13%) or crazy paving pattern (12%). 1 Other associated findings are linear opacities (61%), adjacent pleura thickening (56%) and interlobular thickening (37%). 1 SARS-CoV-2 lung lesions show increased 18 F-FDG uptake, and can be associated with mediastinal or supraclavicular hypermetabolic lymph nodes. 2 No disseminated extrapulmonary lesions from coronavirus SARS-CoV-2 have been yet reported with 18 F-FDG PET/CT, suggesting that this virus may have specific lung tropism, although there is still a limited number of cases described. 2 In the context of the COVID-19 pandemic, the detection of suspicious findings of pneumonia on CT or PET/CT, in both symptomatic or asymptomatic patients, requires further investigation by performing specific PCR and antibody serology tests. In our case, SARS-CoV-2 pneumonia was confirmed on the basis of PET/CT imaging and antibody serology, despite the absence of respiratory symptoms and the negativity of PCR tests. Although an association between SARS-CoV-2 coronavirus infection and midvessel vasculitis in children (Kawasaki disease) 3 has been reported, to date no studies have been published linking directly or indirectly this infection with large vessel vasculitis in adult patients. Therefore, it cannot be assumed in our case that they were two independent nosological entities, as long as there is no advanced knowledge about this new viral infection.

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18 F-FDG PET/CT findings of COVID-19: a series of four highly suspected cases

An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study