Images in cardiovascular medicine

A valuable tool in the assessment of cardiovascular inflammation

A “ring of fire” around the heart: ­pericarditis detected by FDG-PET/CT

DOI: https://doi.org/10.4414/cvm.2018.00576
Publication Date: 19.09.2018
Cardiovasc Med. 2018;21(09):234-235

Giorgio Treglia a,b,c,d, Mariana Raditchkovaa, Luca Ceriania, Luca Giovanellaa

a Clinic of Nuclear Medicine and PET/CT Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

b Health Technology Assessment Unit, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

c Clinical Trial Unit, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

d Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland

FDG-PET/CT enables direct visualisation of inflammatory activity and may represent a useful tool for diagnosis, risk stratification and therapy monitoring in patients with pericarditis.

A 65-year-old man with a previous history of periaortitis was admitted to the emergency department of our hospital because of fever and intermittent chest pain, increasing in intensity and duration.

Inflammatory markers (erythrocyte sedimentation rate, C-reactive protein and leucocyte count) were abnormally increased.

The patient underwent a fluorine-18 fluorodeoxyglucose positron emission tomography / computed tomography (FDG-PET/CT) searching for the origin of this inflammatory syndrome.

PET images showed several areas of increased radio­tracer uptake around the heart, corresponding to a mild pericardial effusion on CT images (fig. 1). This “ring of fire” sign on PET/CT images represents increased metabolic activity around the heart and suggested the presence of acute pericarditis.

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Figure 1: CT (A), PET/CT (B) and PET (C) images in axial projection, PET/CT images in coronal (D) and sagittal (E) projection, and summary PET image (F) show several areas of increased radiotracer uptake around the heart corresponding to a mild ­pericardial effusion at CT images (red arrows).

Based on these FDG-PET/CT findings, the patient was treated with corticosteroids and colchicine with amelioration of symptoms and normalisation of serum inflammatory markers.

FDG-PET/CT offers valuable information in the assessment of cardiovascular inflammation [1–3]. As it enables direct visualisation of inflammatory activity, FDG-PET/CT may represent a useful tool for diagnosis, risk stratification and therapy monitoring in patients with pericarditis.

Disclosure statement

Ethical approval

No financial support and no other potential conflict of interest relevant to this article was reported.

This article has been written in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Correspondence

Correspondence:
Giorgio Treglia, MD MSc(HTA)
Clinic of Nuclear Medicine and PET/CT Centre, Ente Ospedaliero Cantonale
Via Ospedale 12
CH-6500 Bellinzona
giorgio.treglia[at]eoc.ch

References

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2 Colombo J, Elzi L, Treglia G, Perren A. Light in the dark: (18)F-FDG PET/CT in Staphylococcus aureus bacteremia of unknown origin. Intensive Care Med. 2018;44(4):488–9.

3 Kircher M, Lapa C. Novel Noninvasive Nuclear Medicine Imaging Techniques for Cardiac Inflammation. Curr Cardiovasc Imaging Rep. 2017;10(2):6. doi: 10.1007/s12410-017-9400-x.