Positron emission tomography-computed tomography of esophageal adenocarcinoma with vascular invasion and tumor thrombus.

CASE REPORT A 66-year-old man with a several-month history of dysphagia and weight loss presented to a gastroenterologist and underwent upper endoscopy and biopsy. Th is revealed a moderately diff erentiated invasive adenocarcinoma in the distal third of the esophagus. He was then referred for PET-CT, which was performed 60 minutes after the injection of 540.2 MBq F-18 fl ourodeoxyglucose (FDG). PET-CT images demonstrated a hypermetabolic soft tissue mass in the distal third of the esophagus with a maximum standardized uptake value of 16.1, compatible with a known primary malignancy. A linear focus of hypermetabolism was seen coursing posterior and to the right of the esophageal mass and anterior to a thoracic vertebral body (Figure 1). Th is is consistent with tumor thrombus extending into the proximal azygos vein. A hypermetabolic focus was also present in the right atrium. Th ere was no hypermetabolism in the interposed cardiac wall to suggest direct invasion from the large esophageal mass (Figure 2). Findings represented tumor thrombus extension into the right atrium from the extensive tumor thrombus in the azygos system. Th is examination also showed local and distant metastatic disease, including pulmonary metastasis and pulmonary tumor emboli. Discrete hypermetabolic nodules were seen in the right lower lobe as well as the lingula (Figure 3). Th e lingular hypermetabolic nodule had a well-rounded confi guration, more compatible with a metastatic pulmonary nodule (2). Th e right lower lobe lesion was centrally located and corresponded to a segmental lower lobe pulmonary artery, compatible with a metastatic pulmonary embolus from the tumor thrombus that was shown in the right atrium (3).