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22. FDG Uptake in Infectious Mononucleosis.
1Long Island Jewish Medical Center, New Hyde Park, NY, USA
Summary
Positron emission tomography-FDG imaging can mimic lymphoma in adolescents with infectious mononucleosis. Early clinical, hematologic, and serologic assessments are crucial before imaging to avoid misdiagnosis.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Medical Imaging
Background:
- Positron emission tomography-FDG (fluorodeoxyglucose) imaging is increasingly used for lymphoma staging and treatment response monitoring in children.
- An adolescent case presented with symptoms and imaging findings mimicking lymphoma, but was diagnosed with infectious mononucleosis.
Purpose of the Study:
- To highlight a case where infectious mononucleosis mimicked lymphoma on FDG-PET imaging.
- To emphasize the importance of comprehensive clinical evaluation before FDG-PET imaging.
Main Methods:
- A 13-year-old male with a neck mass, fatigue, fever, and weight loss was evaluated for lymphoma.
- Diagnostic workup included complete blood count, erythrocyte sedimentation rate, serologic tests (EBV, CMV, toxoplasmosis, hepatitis), chest X-ray, CT scan, and FDG-PET imaging.
- Final diagnosis was confirmed by positive Monospot and EBV panel results.
Main Results:
- CT scan revealed enlarged cervical lymph nodes with necrosis and massive splenomegaly.
- FDG-PET imaging demonstrated intense uptake in cervical regions, mediastinum, and spleen, consistent with lymphoma.
- Serologic tests confirmed infectious mononucleosis.
Conclusions:
- Infectious mononucleosis can present with clinical and imaging findings similar to lymphoma in adolescents.
- FDG-PET imaging, while sensitive, should be interpreted in conjunction with clinical, hematologic, and serologic data.
- Accurate diagnosis requires a holistic approach, integrating all available diagnostic information.