Abstract
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Introduction: Introduction
We present a rare case of systemic and neurosarcoidosis with intense radiotracer uptake in the neurovascular bundles of lower extremities on F-18 FDG PET-CT.
Methods: Materials and Method:
Review of electronic medical record and institutional PACS.
Results: Case Report:
A 59 year old female presented to our hospital with transient ischemic attack. Initial work up with MRI showed extensive areas of extra-axial enhancement including left greater wing of sphenoid extending into the cavernous sinus and extensive focal leptomeningeal enhancements along cervical and thoracic spine. The differential diagnosis included neurosarcoidosis and lymphoma. PET/CT scan done to rule out lymphoma showed intense F-18 FDG uptake corresponding to the areas of leptomeningeal enhancement on MRI. There were also multiple metabolically active cervical, mediastinal and hilar lymph nodes. Additionally there were numerous focal hypermetabolic activities in the bilateral lower extremities intermuscular regions correlating to the neurovascular bundles.
CSF analysis for further confirmation was negative for lymphoma and showed mild lymphocytic pleocytosis. Left dural based mass biopsy via left craniotomy demonstrated widespread non-necrotizing granulomas and scattered giant cells within a background of fibrous tissue and chronic inflammation in the absence of vasculitis. No evidence of infection was found by special stains or molecular microbiology testing. The findings were consistent with sarcoidosis, a diagnosis of exclusion.
Conclusions: Conclusion:
This is a unique case of systemic sarcoidosis with atypical pattern of F-18 FDG uptake in the neurovascular bundles of bilateral lower extremities. Our case also highlights the value of F-18 FDG PET/CT in determining the extent of disease not shown by other imaging modalities.
Sameday to discuss MRI
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