A case of pleuritis carcinomatosa in which preoperative FDG-PET CTshowed positive uptake and CT scan showed no positive finding

Abstract

We encountered a case of pleuritis carcinomatosa in which PET CT showed enhanced FDG uptake in the pleura, although CT scan showed neither pleural effusion nor nodule presence. A woman had undergone right middle pulmonary lobectomy with ND2a due to pStage IA well differentiated adenocarcinoma at 56 years old. Three years and nine months after this first operation, she underwent a second thoracotomy because CT scanning revealed the recurrent lesion of the interlobar pulmonary stump in the right upper lobe and a metachronous multiple cancer in the right lower lobe. Preoperative PET CT showed enhanced FDG uptake both in the recurrent lesion of the pulmonary stump and in the pleura adjacent to Th8. Intra-operative macroscopic and microscopic findings revealed this enhanced FDG uptake as pleuritis carcinomatosa. Even if CT scan shows neither pleural effusion nor pleural nodule presence in a lung cancer patient, we should carefully decide the operative procedure and expect pleuritis carcinomatosa if PET shows an enhanced FDG uptake lesion in the pleura.