|
 |
| INTERESTING IMAGE |
|
|
|
| Year : 2023 | Volume
: 38
| Issue : 1 | Page : 87-88 |
|
|
18F-Flurodeoxyglucose positron emission tomography/computed tomography findings in a rare case of trichoptysis
Punit Sharma
Department of Nuclear Medicine and PET-CT, Apollo Multispecialty Hospital, Kolkata, West Bengal, India
| Date of Submission | 08-Aug-2022 |
| Date of Acceptance | 22-Sep-2022 |
| Date of Web Publication | 24-Feb-2023 |
Correspondence Address:
Dr. Punit Sharma
Department of Nuclear Medicine and PET-CT, Apollo Multispecialty Hospital, 58, Canal Circular Road, Kolkata - 700 054, West Bengal
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijnm.ijnm_141_22
 Abstract | | |
Trichoptysis or coughing of hairs is a rare symptom, but is pathognomonic for a teratoma with tracheobronchial communication. We present such a rare case with 18F-flurodeoxyglucose positron emission tomography/computed tomography (PET-CT) imaging findings in a 20-year-old female. The diagnosis was made with PET-CT and she underwent curative surgical resection after that.
Keywords: 18F-flurodeoxyglucose, positron emission tomography/computed tomography, teratoma, trichoptysis
How to cite this article:
Sharma P. 18F-Flurodeoxyglucose positron emission tomography/computed tomography findings in a rare case of trichoptysis. Indian J Nucl Med 2023;38:87-8 |
How to cite this URL:
Sharma P. 18F-Flurodeoxyglucose positron emission tomography/computed tomography findings in a rare case of trichoptysis. Indian J Nucl Med [serial online] 2023 [cited 2023 Mar 29];38:87-8. Available from: https://www.ijnm.in/text.asp?2023/38/1/87/370428 |
A 20-year-old female presented with a history of occasional bouts of severe cough with some episodes of mild hemoptysis of 1 year duration. Apart from hemoptysis, she also complained of some “white thread-like substance” coming out with cough during two such episodes. There was no associated chest pain or fever. She had a history of pulmonary tuberculosis 5 years back, which was declared cured after completing 6 months of antitubercular drugs. Recent chest X-ray showed opacity in the left lung upper lobe region. Noncontrast computed tomography (CT) chest was done outside, showing an ill-defined mass in the left lung upper lobe with associated consolidation. Bronchoscopy was normal. CT-guided FNAC from the mass showed only inflammatory cells and no malignant cells. She was refereed for positron emission tomography-CT (PET-CT) for characterization of the mass. Contrast-enhanced 18F-flurodeoxyglucose (18F-FDG) PET-CT was performed following usual protocols. In the waiting room, after 18F-FDG injection, the patient had a severe bout of cough. While there was no hemoptysis, “white thread-like substance” did come out with mucoid sputum [Figure 1]a. Once the patient stabilized, PET-CT was performed. Maximum intensity projection PET image [Figure 1]b showed a patchy area of mild 18F-FDG uptake in the left upper lobe region (bold arrow), along with physiological 18F-FDG uptake in the thymus (arrow). Coronal [Figure 1]c and [Figure 1]d and transaxial [Figure 1e and f] contrast-enhanced CT and PET-CT images showed a lobular well-defined left anterior mediastinal mass, measuring 50 mm × 37 mm × 37 mm with no focal FDG uptake. The mass has fatty and fluid components along with enhancing solid non-FDG avid component (bold arrows). Adjacent atelectasis was in the left lung upper lobe with minimal 18F-FDG uptake. The findings were classical of a mature teratoma. No other abnormality was seen in the rest of the body. The “white thread-like substance” was preserved and sent for pathological examination, which confirmed them to be hairs. The patient then underwent surgical removal of the tumor with left upper lobectomy and postoperative histopathology confirmed the diagnosis. She is completely asymptomatic at 2-year follow-up. | Figure 1: “White thread-like substance” coming out with mucoid sputum, later confirmed to be hairs (a). Maximum intensity projection PET image (b) showed a mild patchy area of 18F-FDG uptake in the left upper lobe region (bold arrow), along with physiological 18F-FDG uptake in the thymus (arrow). Coronal (c and d) and transaxial (e and f) contrast-enhanced CT and PET-CT images showed a lobular well-defined left anterior mediastinal mass, measuring 50 mm × 37 mm × 37 mm with no focal FDG uptake. The mass has fatty and fluid components along with enhancing solid non-FDG avid component (bold arrows). Adjacent atelectasis was in the left lung upper lobe with minimal 18F-FDG uptake. The findings were classical of a mature teratoma. No other abnormality was seen in the rest of the body
Click here to view |
Mature teratoma is one of the most common causes of anterior mediastinal mass in young females.[1] Pulmonary parenchymal or airway involvement of mediastinal teratoma is rare occurrence and variably labeled as pulmonary rupture or pulmonary parenchymal teratoma fistula.[2] Coughing up of hairs or “trichoptysis” is a rare symptom, but pathognomonic of a teratoma having tracheobronchial communication.[3],[4] The incidence of this complication is exceedingly rare and is seen more commonly with cystic lesion (as in the present case) than solid lesion.[3] Imaging plays an important role in diagnosis.[5] 18F-FDG PET-CT plays a complementary role in making the diagnosis. Identification is important as surgery is curative.[6]
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Lewis BD, Hurt RD, Payne WS, Farrow GM, Knapp RH, Muhm JR. Benign teratomas of the mediastinum. J Thorac Cardiovasc Surg 1983;86:727-31.  |
| 2. | Choi SJ, Lee JS, Song KS, Lim TH. Mediastinal teratoma: CT differentiation of ruptured and unruptured tumors. AJR Am J Roentgenol 1998;171:591-4. |
| 3. | Guibert N, Attias D, Pontier S, Berjaud J, Lavialle-Guillautreau V, Didier A. Mediastinal teratoma and trichoptysis. Ann Thorac Surg 2011;92:351-3. |
| 4. | Makarawo TP, Finnikin S, Woolley S, Bishay E. Trichoptysis: A hairy presentation of a rare tumour. Interact Cardiovasc Thorac Surg 2009;9:733-5. |
| 5. | Upadhyay A, Verma A, Sharma J, Shukla RC, Srivastava A. Imaging of trichoptysis – How a radiologist can help? Int J Trichology 2014;6:177-9. |
| 6. | Matsuoka H, Matsubara H, Sugimura A, Uchida T, Ichihara T, Nakajima H. Mediastinal mature teratoma perforating the right lung that was successfully resected with complete thoracoscopic surgery: A case report. Int J Surg Case Rep 2018;53:299-302. |
[Figure 1]
|
