Dilated Internal Thoracic Vertebral Venous Plexus Simulating Bone Metastases on FDG PET/CT

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Abstract

A 42-year-old woman with a newly diagnosed malignant thymoma underwent FDG PET/CT, which demonstrated an increased uptake in anterior mediastinal tumor and several pleural masses in the right hemithorax, compatible with “drop metastases.” In addition, contrast-enhanced CT images showed hyperdense abnormality in T2 vertebral body, congruent with intensely increased FDG uptake, raising suspicion of skeletal metastasis. This is a rare but important potential pitfall either in CT and FDG PET/CT—a “false-positive” bony lesion not attributed to skeletal metastasis but to dilated internal thoracic vertebral venous plexus associated with collateral circulation due to superior vena cava syndrome.

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