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Thymic Extension in the Superior Mediastinum in Patients with Thymic Hyperplasia: Potential Cause of False-Positive Findings on 18F-FDG PET/CT

Clare S. Smith1, Heiko Schöder and Henry W. D. Yeung

1 All authors: Department of Radiology/Nuclear Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.


Figure 1
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  		Fig. 1A —3.5-year-old boy with abdominal Burkitt's lymphoma. Axial CT image from 18F-FDG PET/CT study performed before chemotherapy shows small 2-mm nodule (arrow), which is not FDG avid, anteromedial to left brachiocephalic vein.

 

Figure 2
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  		Fig. 1B —3.5-year-old boy with abdominal Burkitt's lymphoma. Axial CT image from FDG PET/CT study performed 5 months after treatment shows enlargement of nodule (arrow). Nodule now measures 7 mm.

 

Figure 3
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  		Fig. 1C —3.5-year-old boy with abdominal Burkitt's lymphoma. Axial fusion FDG PET/CT image obtained 5 months after treatment shows that FDG activity corresponds to enlarged nodule anteromedial to left brachiocephalic vein (arrow).

 

Figure 4
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  		Fig. 1D —3.5-year-old boy with abdominal Burkitt's lymphoma. Axial fusion FDG PET/CT image performed 5 months after treatment shows increased activity in enlarged thymus (arrow) (standardized uptake value, 2.0) of similar intensity to activity in superior mediastinum.

 

Figure 5
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  		Fig. 1E —3.5-year-old boy with abdominal Burkitt's lymphoma. Coronal FDG PET scan obtained 12 months after completion of treatment shows persistent activity in thymus and in superior thymic extension (arrow). Note physiologic activity within right neck in sternocleidomastoid muscle.

 

Figure 6
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  		Fig. 2A —3-year-old girl with hepatoblastoma. Contrast-enhanced CT image obtained 6 months after completion of chemotherapy shows soft-tissue nodule in superior mediastinum (arrow).

 

Figure 7
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  		Fig. 2B —3-year-old girl with hepatoblastoma. Axial PET image from 18F-FDG PET/CT study shows increased FDG activity in superior mediastinum (arrow) (standardized uptake value [SUV], 3.2). SUV of activity in thymus was 3.6.

 

Figure 8
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  		Fig. 3A —14-year-old boy with B-cell lymphoma of right elbow. Coronal 18F-FDG PET image at time of diagnosis shows physiologic FDG activity in thymus (black arrow) and increased activity at right elbow (white arrow) consistent with patient's known disease.

 

Figure 9
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  		Fig. 3B —14-year-old boy with B-cell lymphoma of right elbow. Axial CT image from FDG PET/CT study obtained 8 months after completion of therapy shows nodule in superior mediastinum (arrow). This nodule is somewhat obscured by beam-hardening artifact.

 

Figure 10
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  		Fig. 3C —14-year-old boy with B-cell lymphoma of right elbow. Coronal PET image from FDG PET/CT study performed 8 months after completion of chemotherapy shows increased FDG activity in thymus and superior extension in superior mediastinum (arrow).

 

Figure 11
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  		Fig. 3D —14-year-old boy with B-cell lymphoma of right elbow. Sagittal PET image from PET/CT study performed 8 months after completion of chemotherapy shows increased FDG activity in thymus and superior extension in mediastinum (arrows).

 

Figure 12
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  		Fig. 4 —Drawing of anterior view of thyroid gland, thymus, and parathyroid glands illustrates various congenital anomalies that may occur. (Reprinted with permission from Moore KL, Persaud TVN. The developing human, 6th ed. Philadelphia, PA: W. B. Saunders, 1998:230 [8])

 

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