Case Author(s): Xia Wang, M.D., Quan Vu, M.D. and Tom R. Miller, M.D., PhD. , . Rating: #D3, #Q4

Diagnosis: Extensive and Intense Muscle Uptake

Brief history:

19-year-old female with cystic fibrosis


Coronal PET Images.

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View second image(pt). Axial PET/CT Images through the chest.

View third image(pt). Axial PET/CT images through the neck.

Full history/Diagnosis is available below

Diagnosis: Extensive and Intense Muscle Uptake

Full history:

This is a 19-year-old female with cystic fibrosis who has undergone bilateral lung transplant, complicated with possible bronchiolitis obliterans. This study is ordered to evaluate for possible post-transplant lymphoproliferative disease (PTLD).


18F-Fluorodeoxyglucose i.v.


Extensive and intense muscle uptake is present throughout the visualized field of view. There is increased FDG uptake in the intercostal muscles, the accessory respiratory muscles, including the sternocleidomastoid muscles in the neck, abdominal muscles, and the crus of the diaphragm. Increased FDG uptake is also noted in the muscles in both upper and lower extremities. There was no evidence of PTLD on the current study.


This is a complicated case in which we had difficulty controlling the patient's blood glucose. The patient was hyperglycemia from chronic steroid use. Before coming to the Department, the patient had an Insulin drip to bring down her blood glucose. Before the examination, her Insulin drip was turned off, but glucose control continued to be difficult. The extensive and intense muscle uptake is most likely due to the patient's hyperinsulinemia as well as labored breathing.

Major teaching point(s):

Undesirably increased physiologic muscle uptake is occasionally encountered on 18F-FDG PET scans. It is desirable that the patient not tense muscles during the FDG uptake phase. It is also important to control blood glucose within normal limits and to avoid hyperinsulinemia which was not possible in this case.

ACR Codes and Keywords:

References and General Discussion of PET Tumor Imaging Studies (Anatomic field:Skeletal System, Category:Misc)

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Case number: pt153

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