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Diagnosis of benign solitary fibrous tumors by positron emission tomography.

Article Excerpt
Abstract: An 80-year-old male presented with dyspnea so severe that he could not perform the activities of daily living. Chest radiography and computed tomography of the chest demonstrated a 30-cm left chest mass extending inferiorly to displace the left kidney and spleen. Three incisional biopsies yielded inconclusive results. Positron emission tomography (PET) with fluorodeoxyglucose F 18 (FDG) ruled out malignancy, so a curative excisional biopsy was performed. We conclude that FDG PET is a crucial component of the initial evaluation of patients with solitary pulmonary masses. FDG PET has high sensitivity, specificity, positive predictive value, and negative predictive value in the diagnostic clarification of radiologically indeterminate pulmonary lesions.

Key Words: dyspnea, emission-computed tomography, fluorodeoxyglucose F 18, pleural mesothelioma, x-ray computed tomography

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A solitary intrathoracic, pleura-based mass in an older patient presents a challenge to clinicians. The differential diagnosis includes benign and malignant mesothelioma, metastatic tumor, schwannoma, neurofibroma, lipoma, hematoma, mesothelial cyst, empyema, and effusion. Since accurate diagnosis is a crucial requisite for effective intervention, precise tools to quickly ascertain the underlying pathophysiology are welcome. Positron emission tomography (PET) with fluorodeoxyglucose F 18 (FDG) is a noninvasive technique to both (1) stage non-small cell carcinomas of the lung (1) and (2) determine the malignant potential of solitary pulmonary nodules. (1-3) The glycolytic activity of masses can be assessed by means of PET to estimate the likelihood of the presence of a malignant process. (1,2) We report the diagnostic value of FDG PET in the case of an 80-year-old male with a large tumor of the thorax of unknown cause.

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