Lighting Up

Cyriac Abby Philips, MD

December 15, 2016

A 66-year-old man complaining of progressive dysphagia to solids over the past 6 months was referred to our outpatient department for evaluation of multiple space-occupying lesions in his liver. His dysphagia was associated with a significant unintentional weight loss of 15 kg over the past 3 months as well as a 2-week history of recurrent episodes of foul-smelling regurgitation. He denied any fevers, drenching night sweats, or bone pains. He had chewed tobacco for 25 years, but otherwise, his past medical and social history were non-contributory. Whole body positron emission tomography scan (PET-CT, GE ® Discovery STE-BGO Crystal, 18F-Fluro-deoxy-glucose (FDG) revealed a long segment of FDG-avid, lobulated mural thickening involving the distal thoracic esophagus (figure 1A), the gastro-esophageal junction, gastric cardia, fundus, and the lesser curvature of the gastric body, as well as regions of FDG uptake in both hepatic lobes (figure 1B). A final diagnosis of metastatic esophageal carcinoma was made. The PET-CT also revealed another interesting finding (figure 1C).