Diagnostic value of PET/CT for giant cell arteritis combined with pulmonary embolism presenting: Case report and literature review.
Diagnostic value of PET/CT for giant cell arteritis combined with pulmonary embolism presenting: Case report and literature review.
复制标题
PET/CT对巨细胞动脉炎合并肺栓塞的诊断价值：病例报告及文献复习
DOI：
10.1097/md.0000000000007651
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发表时间：
2017-08
期刊：
影响因子：
1.6
通讯作者：
Wang G
中科院分区：
文献类型：
--
作者：
Shu X;Xu X;Peng Q;Lu X;Ma L;Mi N;Wang G
巨细胞动脉炎(GCA)合并肺栓塞(PE)因其发病率低、临床表现不典型而极难诊断。一名62岁男性出现原因不明的发烧。正电子发射断层扫描/计算机断层扫描(PET/CT)显示升主动脉、降主动脉和肺动脉血管壁糖代谢增加，诊断为GCA合并PE。患者对常规的抗病毒和抗菌治疗没有反应，但在类固醇治疗后得到缓解。这位患者没有特定的自身抗体呈阳性，患者对常规的抗病毒和抗菌治疗没有反应。经PET/CT确诊后，患者对激素治疗反应良好。文献复习发现16例经PET/CT诊断为GCA。中位年龄68.5岁(21~87岁)，女性13例。PET/CT显示升主动脉、降主动脉、腹主动脉和颈动脉代谢显著增加。4例(包括本组病例)平均最大标准摄取值为4 2 ± 1 7(范围2 5~7 2)。6例GCA合并PE，女性5例(6/7，85.7%)，本病例为首例男性GCA合并PE。5例均开始激素治疗。4例完全缓解，2例死亡，1例转归不明。我们的病例和综述强调了PET/CT在诊断GCA合并PE中的价值，提示PET/CT是表现为发热或肌肉疼痛的不典型患者的首选诊断工具。
Giant cell arteritis (GCA) combined with concomitant pulmonary embolism (PE) is extremely difficult to diagnose because of its low incidence and atypical clinical presentations. A 62-year-old male developed fever of unknown origin. Positron emission tomography/computed tomography (PET/CT) revealed increased glucose metabolism in the vascular walls of the ascending and descending aorta and pulmonary artery, leading to a diagnosis of GCA combined with PE. The patient did not respond to regular antiviral and antibacterial treatment but was remised after steroid treatment. No specific autoantibodies were positive for this patient, and the patient did not respond to regular antiviral and antibacterial treatment. After diagnosed by PET/CT, the patient responded well to steroid treatment. Literature review found 16 cases of GCA diagnosed by PET/CT. Their median age was 68.5 (range, 21–87) years and 13 cases were female. PET/CT showed significantly increased metabolism in the ascending and descending aorta, abdominal aorta, and carotid artery. In 4 cases (including our own case), the mean maximum standardized uptake value was 4.2 ± 1.7 (range, 2.5–7.2). Six cases of GCA also had PE and 5 (6/7, 85.7%) cases were females, and the current case is the first male case of GCA combined with PE. Steroid therapy was initiated in all 5 cases. Complete remission was achieved in 4 cases and 2 patients died and the outcome of 1 patient was unknown. Our case and the review highlight the value of PET/CT in diagnosing GCA combined with PE, suggesting that PET/CT is the preferred diagnostic tool for atypical patients presenting with fever or muscle pain.