FDG PET/CT imaging to rule out extrahepatic metastases before liver transplantation

FDG PET/CT, an established imaging modality for staging and restaging workup of malignancies, also demonstrates increased uptake in infectious or inflammatory conditions, including both infectious and noninfectious granulomatous processes. A 65-year-old man with a history of hepatocellular carcinoma status post-wedge resection and chemoembolization of the primary tumor referred for evaluation of extrahepatic metastases for determining the surgical eligibility for a liver transplantation. The patient underwent FDG PET/CT imaging associated with a separately acquired contrast enhanced CT (CECT) of the chest, abdomen, and pelvis. FDG PET/CT imaging revealed multiple FDG-avid pulmonary nodules that were subsequently confirmed to represent Mycobacterium avium intracellular infection on histology.