Pseudolesions Impersonating Osseous Tumor Involvement on Both Contrast Enhanced CT and FDG PET/CT

A 27-year-old man with stage IV-B Hodgkin's lymphoma status post autologous peripheral stem cell transplant in 2015 with complete response, presented in 2017 with increasing back pain. Restaging contrast enhanced CT demonstrated left brachiocephalic vein occlusion with peripheral nodular high density areas within C7-T2 vertebral bodies with corresponding radiotracer uptake on same day PET/CT. No matching lesion was seen on noncontrast CT. Findings were consistent with pooling of contrast and radiotracer within vertebral venous plexus collaterals at the cervicothoracic junction secondary to brachiocephalic vein occlusion. Repeat PET/CT with contralateral injection of radiotracer and MRI confirmed absence of osseous lymphomatous involvement.