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Disseminated Multi-system Sarcoidosis Mimicking Metastases on 18F-FDG PET/CT


  • William Makis
  • Mark Palayew
  • Christopher Rush
  • Stephan Probst

Received Date: 02.10.2017 Accepted Date: 26.11.2017 Mol Imaging Radionucl Ther 2018;27(2):91-95

A 60-year-old female with no significant medical history presented with hematuria. A computed tomography (CT) scan revealed extensive lymphadenopathy with hypodensities in the liver and spleen, and she was referred for an 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/CT (PET/CT) study to assess for malignancy of unknown primary. PET/CT revealed extensive 18F-FDG avid lymphadenopathy as well as innumerable intensely 18F-FDG avid lung, liver and splenic nodules, highly concerning for malignancy. A PET-guided bone marrow biopsy of the posterior superior iliac spine revealed several non-necrotizing, well-formed granulomas, consistent with sarcoidosis. The patient was managed conservatively and remained clinically well over the subsequent 9 years of follow-up.

Keywords: Sarcoidosis, artifact, mimic, lymphadenopathy, metastases, 18F-fluorodeoxyglucose, positron emission tomography


Informed Consent: All subjects in the study gave written informed consent or the institutional review board waived the need to obtain informed consent.

Peer-review: Externally and internally peer-reviewed.

Authorship Contributions

Surgical and Medical Practices: W.M., M.P., C.R., S.P., Concept: W.M., M.P., C.R., S.P., Design: W.M., M.P., C.R., S.P., Data Collection or Processing: W.M., M.P., C.R., S.P., Analysis or Interpretation: W.M., M.P., C.R., S.P., Literature Search: W.M., M.P., C.R., S.P., Writing: W.M., M.P., C.R., S.P.

Conflict of Interest: William Makis, Mark Palayew, Christopher Rush and Stephan Probst declare that they have no conflicts of interest.

Financial Disclosure: The authors declare that this study has received no financial support.

  1. Judson MA. Sarcoidosis: clinical presentation, diagnosis, and approach to treatment. Am J Med Sci 2008;335:26-33.
  2. Aberg C, Ponzo F, Raphael B, Amorosi E, Moran V, Kramer E. FDG positron emission tomography of bone involvement in sarcoidosis. AJR Am J Roentgenol 2004;182:975-977.
  3. Zhuang H, Alavi A. 18-fluorodeoxyglucose positron emission tomographic imaging in the detection and monitoring of infection and inflammation. Semin Nucl Med 2002;32:47-59.
  4. Ludwig V, Fordice S, Lamar R, Martin WH, Delbeke D. Unsuspected skeletal sarcoidosis mimicking metastatic disease on FDG positron emission tomography and bone scintigraphy. Clin Nucl Med 2003;28:176-179.
  5. Cook GJ, Fogelman I, Maisey MN. Normal physiological and benign pathological variants of 18-fluoro-2-deoxyglucose positron-emission tomography scanning: potential for error in interpretation. Semin Nucl Med 1996;26:308-314.
  6. Teirstein AS, Machac J, Almeida O, Lu P, Padilla ML, Iannuzzi MC. Results of 188 Whole Body FDG PET Scans in 137 Patients with Sarcoidosis. Chest 2007;132:1949-1953.
  7. Makis W, Probst S. Extensive polyostotic fibrous dysplasia evaluated for malignant transformation with 99mTc-MDP bone scan and 18F-FDG PET/CT. BJR Case Rep 2016;2:1-4.
  8. Makis W, Stern J. Chronic vascular graft infection with fistula to bone causing vertebral osteomyelitis, imaged with F-18 FDG PET/CT. Clin Nucl Med 2010;35:794-796.
  9. Aoki J, Watanabe H, Shinozaki T, Takagishi K, Ishijima H, Oya N, Sato N, Inoue T, Endo K. FDG PET of primary benign and malignant bone tumors: standardized uptake value in 52 lesions. Radiology 2001;219:774-777.
  10. Kobayashi A, Shinozaki T, Shinjyo Y, Kato K, Oriuchi N, Watanabe H, Takagishi K. FDG PET in the clinical evaluation of sarcoidosis with bone lesions. Ann Nucl Med 2000;14:311-313.
  11. Sobic-Saranovic D, Artiko V, Obradovic V. FDG PET imaging in sarcoidosis. Semin Nucl Med 2013;43:404-411.
  12. Warshauer DM, Molina PL, Hamman SM, Koehler RE, Paulson EK, Bechtold RE, Perlmutter ML, Hiken JN, Francis IR, Cooper CJ, et al. Nodular sarcoidosis of the liver and spleen: analysis of 32 cases. Radiology 1995:195:757-762.
  13. Soussan M, Augier A, Brillet PY, Weinmann P, Valeyre D. Functional imaging in extrapulmonary sarcoidosis: FDG-PET/CT and MR features. Clin Nucl Med 2014;39:e146-159.