Contribution of PET/CT imaging to differential diagnosis of fever of unknown origin.

BACKGROUND: Vasculitis is a collective title for a heterogeneous group of diseases with common signs of inflammation, leukocytic infiltration and necrosis of the vessel wall leading to regional perfusion disturbances. There are many ways to classify vasculitis. Into the group of large-vessel vasculitis we include Takayasu´s arteritis as well as temporal arteritis (giant-cell arteritis) affecting also the aorta and its major branches. METHODS: FDG PET/CT is a hybrid imaging method combining spatial imaging of metabolic activity obtained by the detection of 18-fluorodeoxyglucose (FDG) with positron emission tomography (PET) and X-ray computed tomography (CT). While carried out together with PET imaging in the same session, CT imaging is helpful in identifying precisely the anatomical identification of hypermetabolic lesions detected via PET. RESULTS: In this case report we refer to the key contribution of PET/CT imaging to concluding successfully a diagnostic process lasting for a few months and leading to a revelation of large-vessel vasculitis manifesting itself only with systemic inflammation symptoms, i.e. without any clinical signs of specific organ damage. CONCLUSION: In conclusion, FDG PET/CT scan is a combined imaging technique which has a remarkable potential in the diagnosis of large-vessel vasculitis. This potential is particularly valued in cases when symptoms of vasculitis are clinically nonspecific and when other non-invasive methods are failing (Fig. 2, Ref. 20).

[Benign solitary cecal ulcer]. / Benígny solitárny vred slepého creva.

Solitary benign cecal ulcer is a non-usual finding without characteristic clinical or radiological performance. Because ofits little frequency and its clinical symptoms often suspicious for the presence of severe diseases like are malignancies, acute abdomen or lower gastrointestinal bleeding, this finding is only rarely diagnosed preoperatively. Definitive diagnosis is almost always made pathologically. In this case report we describe clinical, radiological and pathological findings in our patient with difficulties caused by a solitary benign cecal ulcer.

[Symmetrical phlebothrombosis of lower extremities resulting from congenital malformation of vena cava inferior]. / Obojstranná flebotrombóza dolných koncatín zaprícinená vrodenou malformáciou dolnej dutej zily.

Agenesis/atresia ofvena cava inferior is a rare congenital anomaly, caused by an aberrance of embryonal venous system development. This is in most cases asymptomatic, because of well developed collateral venous circulation. However, in some cases, it can be manifested with occurence of deep thrombosis in area of pelvis and lower limbs. In this case report, we repon a 21 year old male with painful swelling of both lower limbs. Ultrasonographic examination revealed a bilateral thrombosis in deep venous system of lower limbs and pelvis. Subsequent CT angiography showed atresia ofinfrarenal segment ofvena cava inferior. According to the CT image thrombotic proces affected also collateral venous system, that joined mostly to vena azygos and hemiazygos. Examination of coagulation system didn't reveal a procuring cause ofthrombotic occurrence. We realized a systemic trombolysis with streptokinase during 5 days. Starting from the fifth day we administered a low molecular weight heparin in anticoagulant dose. This treatment showed a good clinical effect. Pacient was discharged with a long-term oral warfarin therapy in combination with acetylsalicylic acid. In next four months of taking recommended therapy no relapse of thrombotic process nor evolvement of bleeding complication was observed.