Dual-Time-Point PET/CT to Differentiate Fluorodeoxyglucose-Avid Hiatal Hernia From Mediastinal Malignancy

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It has been reported that a hiatal hernia may accumulate F-18 fluorodeoxyglucose (FDG) and such a focal F-18 FDG activity detected in the middle–posterior mediastinum usually raises the unnecessary suspicion of malignancy. The F-18 FDG uptake might be the result of physiological gastric activity or an inflammatory process associated with gastroesophageal reflux in a hiatal hernia patient. For the suspected esophageal hiatal lesion, diminished F-18 FDG activity on delayed imaging and identification of gastrointestinal loops by coregistered computed tomography could assist with the diagnosis of a hiatal hernia. We describe a case of hiatal hernia featuring a paraesophageal mass with disappearing F-18 FDG avidity in the middle–posterior mediastinum during a PET scan for cancer workup.

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