Unexpected Fibrosing Mediastinitis Shown on FDG PET/CT in a Patient With IgG4-Related Disease
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Updated: Feb 24, 2026
Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
Published on: June 16, 2020
Ying Kan1, Leilei Yuan, Wei Wang
1From the Department of Nuclear Medicine, Beijing Friendship Hospital of Capital Medical University, Beijing, China.
Abstract:
A 66-year-old man presented to our hospital because of abdominal pain for 5 days. A contrast abdominal CT raised the possibility of pancreatic carcinoma. FDG PET/CT showed increased FDG accumulation not only in the pancreas and the retroperitoneum, but also in the posterior mediastinum, which was not typical of pancreatic carcinoma. The patient was subsequently diagnosed having immunoglobulin G4-related disease following the histopathologic examination.
Insights
This case highlights immunoglobulin G4-related disease (IgG4-RD) mimicking pancreatic cancer. FDG PET/CT revealed unusual uptake patterns, aiding diagnosis beyond typical pancreatic carcinoma presentation.
Area of Science:
- Gastroenterology
- Oncology
- Radiology
- Immunology
Background:
- Pancreatic carcinoma is a common cause of abdominal pain and can present with nonspecific findings.
- Immunoglobulin G4-related disease (IgG4-RD) is a fibroinflammatory condition that can affect multiple organs, including the pancreas.
Observation:
- A 66-year-old male presented with 5 days of abdominal pain.
- Contrast-enhanced abdominal CT suggested pancreatic carcinoma.
- FDG PET/CT demonstrated increased FDG uptake in the pancreas, retroperitoneum, and posterior mediastinum.
Findings:
- The atypical FDG PET/CT findings in the posterior mediastinum were not characteristic of pancreatic carcinoma.
- Histopathologic examination confirmed the diagnosis of immunoglobulin G4-related disease (IgG4-RD).
Implications:
- This case underscores the importance of considering IgG4-RD in the differential diagnosis of pancreatic lesions, especially with unusual imaging findings.
- Integrated imaging modalities like FDG PET/CT are crucial for differentiating IgG4-RD from malignancy.
- Accurate diagnosis of IgG4-RD is essential for appropriate treatment and management, preventing unnecessary pancreatic cancer interventions.
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