A 40-year-old female patient presented with tightness of chest for 15 days, history of weight loss, decreased appetite, body pains, weakness, and no history of fever. Laboratory investigations revealed ESR 118 mm/h, CRP >24 mg/L, total leukocyte count 10,100 cells/cu mm. ANA, Rheumatoid factor (RF), anti-cyclic citrullinated peptide were negative. Patient underwent contrast-enhanced CT chest that revealed mediastinal lymphadenopathy, left minimal pleural effusion, pericardial effusion, and hypodense lesions in liver. There was a clinical suspicion of malignancy and the patient was referred for 18F-FDG PET-CT.
On 18F-FDG PET-CT, MIP image revealed foci of increased FDG uptake in mediastinum. Transaxial images showed increased FDG uptake involving enlarged mediastinal lymph nodes, thickened walls of ascending aorta and arch of aorta and pericardial thickening with effusion [Figure 3]. Non-FDG avid left pleural thickening was noted. PET-CT findings were suggestive of extrapulmonary TB with aortoarteritis. Patient was treated with ATT for 9 months. Follow-up 18F-FDG PET-CT was carried out after 6 months of treatment which showed complete metabolic and morphologic response [Figure 4].