From pericarditis to giant cell arteritis: leveraging FDG PET CT for accurate diagnosis and treatment

Fatima K Alduraibi

PMC · DOI:10.1093/rap/rkaf019·February 19, 2025

From pericarditis to giant cell arteritis: leveraging FDG PET CT for accurate diagnosis and treatment

Fatima K Alduraibi

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Abstract

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Diseases2

giant cell arteritis pericarditis

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a](#rkaf019-F1), arrows), pericardial wall thickening with mild enhancement ([Fig. 1b](#rkaf019-F1), arrowhead) and pericardial effusion ([Fig. 1b](#rkaf019-F1), arrow). Fused coronal FDG PET/CT ([Fig. 1c](#rkaf019-F1)) and fused axial FDG PET/CT ([Fig. 1d](#rkaf019-F1)) demonstrated increased FDG uptake in the walls of the ascending aorta ( arrow), descending aorta and bilateral iliac arteries, confirming vasculitis consistent with giant cell arteritis. An axial non-enhanced chest CT ([Fig. 1e](#rkaf019-F1)) showed circumferential aortic wall thickening with mild fat stranding ( arrow).

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Taxonomy

TopicsVasculitis and related conditions · Myasthenia Gravis and Thymoma · Pericarditis and Cardiac Tamponade

Full text

An 81-year-old female with a past medical history of atrial fibrillation and sick sinus syndrome presented with persistent chest pain, low-grade fever and malaise. Initial workup revealed elevated CRP (204), ESR (41) and a moderate pericardial effusion without vegetation on echocardiogram. She was diagnosed with idiopathic pericarditis and treated with ibuprofen and colchicine.

She returned with recurrent fever, persistently high CRP (244), ESR (56) and leucocytosis. Haematologic, autoimmune and infectious studies were unremarkable. Repeat echocardiogram showed a small pericardial effusion, while cardiac MRA ruled out vasculitis. Axial enhanced chest CT revealed circumferential aortic wall thickening with enhancement and mild fat stranding (Fig. 1a, arrows), pericardial wall thickening with mild enhancement (Fig. 1b, arrowhead) and pericardial effusion (Fig. 1b, arrow). Fused coronal FDG PET/CT (Fig. 1c) and fused axial FDG PET/CT (Fig. 1d) demonstrated increased FDG uptake in the walls of the ascending aorta ( arrow), descending aorta and bilateral iliac arteries, confirming vasculitis consistent with giant cell arteritis. An axial non-enhanced chest CT (Fig. 1e) showed circumferential aortic wall thickening with mild fat stranding ( arrow).

She was started on prednisone, leading to clinical improvement. A 4-month follow-up FDG PET/CT showed normal FDG distribution and resolution of the prior findings (Fig. 1f–g).