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Lee K. Brown, MD, FCCP; Shadi Battah, MD; Cecilia Wu, MD; Allyson Richards, MD; Lida Crooks, MD; Michael Hartshorne, MD
Author and Funding Information

From the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine (Dr Brown), the Department of Pathology (Drs Wu and Crooks), and the Department of Radiology (Drs Richards and Hartshorne), University of New Mexico School of Medicine; and The Alaska Hospitalist Group (Dr Battah).

Correspondence to: Lee K. Brown, MD, FCCP, Department of Internal Medicine, University of New Mexico School of Medicine, 1101 Medical Arts Ave NE, Bldg #2, Albuquerque, NM 87102; e-mail: lkbrown@alum.mit.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Brown cochairs the Polysomnography Practice Advisory Committee of the New Mexico Medical Board and serves on the New Mexico Respiratory Care Advisory Board. He currently receives no grant or commercial funding pertinent to the subject of this article. Drs Battah, Wu, Richards, Crooks, and Hartshorne have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(4):967. doi:10.1378/chest.10-3290
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To the Editor:

We thank Dr Nair for his pertinent comments concerning the use of fluorodeoxyglucose (FDG)-PET scanning in the evaluation of pleural disease. As we made clear in our description of a case of pleural disease associated with ankylosing spondylities (AS) recently published in CHEST (October 2010),1 FDG-PET scan-avid pleural lesions only denote increased metabolic activity within the area of interest but do not provide specific information concerning the source of that activity, which may be neoplastic or inflammatory.2 As is true for many imaging modalities, on some occasions the clinical scenario and/or radiographic appearance are such that a specific nonmalignant diagnosis can be made with enough confidence to obviate the need for an invasive procedure. Clearly, in our patient with a history of tobacco use and possible asbestos exposure it was mandatory that a firm, histologic diagnosis be pursued.

Nevertheless, we believe it is important to remind clinicians that FDG-PET scan avidity has been demonstrated in a wide variety of inflammatory disorders affecting the lungs and pleura, including infection as well as noninfectious granulomatous disease, such as those produced by talc pleurodesis or due to sarcoidosis.3,4 However, the appearance of pleural disease associated with collagen vascular disorders on FDG-PET scan has only rarely been reported. Rheumatoid arthritis with FDG-PET scan-avid pleural involvement has been described in only one previous report.5 Spinal lesions with FDG-PET scan avidity are known to occur in patients with AS,6 but it appears that our case is the first to describe FDG-PET scan positivity in pleural disease due to AS.

Battah S, Wu C, Richards A, Crooks L, Hartshorne M, Brown LK. A 41-year-old man with fluorodeoxyglucose-avid thickening on PET scan. Chest. 2010;1384:1010-1013. [CrossRef] [PubMed]
 
Duet M, Pouchot J, Lioté F, Faraggi M. Role for positron emission tomography in skeletal diseases. Joint Bone Spine. 2007;741:14-23. [CrossRef] [PubMed]
 
Love C, Tomas MB, Tronco GG, Palestro CJ. FDG PET of infection and inflammation. Radiographics. 2005;255:1357-1368. [CrossRef] [PubMed]
 
Alavi A, Gupta N, Alberini JL, et al. Positron emission tomography imaging in nonmalignant thoracic disorders. Semin Nucl Med. 2002;324:293-321. [CrossRef] [PubMed]
 
Bagga S. Rheumatoid lung disease as seen on PET/CT scan. Clin Nucl Med. 2007;329:753-754. [CrossRef] [PubMed]
 
Wendling D, Blagosklonov O, Streit G, Lehuédé G, Toussirot E, Cardot J-C. FDG-PET/CT scan of inflammatory spondylodiscitis lesions in ankylosing spondylitis, and short term evolution during anti-tumour necrosis factor treatment. Ann Rheum Dis. 2005;6411:1663-1665. [CrossRef] [PubMed]
 

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References

Battah S, Wu C, Richards A, Crooks L, Hartshorne M, Brown LK. A 41-year-old man with fluorodeoxyglucose-avid thickening on PET scan. Chest. 2010;1384:1010-1013. [CrossRef] [PubMed]
 
Duet M, Pouchot J, Lioté F, Faraggi M. Role for positron emission tomography in skeletal diseases. Joint Bone Spine. 2007;741:14-23. [CrossRef] [PubMed]
 
Love C, Tomas MB, Tronco GG, Palestro CJ. FDG PET of infection and inflammation. Radiographics. 2005;255:1357-1368. [CrossRef] [PubMed]
 
Alavi A, Gupta N, Alberini JL, et al. Positron emission tomography imaging in nonmalignant thoracic disorders. Semin Nucl Med. 2002;324:293-321. [CrossRef] [PubMed]
 
Bagga S. Rheumatoid lung disease as seen on PET/CT scan. Clin Nucl Med. 2007;329:753-754. [CrossRef] [PubMed]
 
Wendling D, Blagosklonov O, Streit G, Lehuédé G, Toussirot E, Cardot J-C. FDG-PET/CT scan of inflammatory spondylodiscitis lesions in ankylosing spondylitis, and short term evolution during anti-tumour necrosis factor treatment. Ann Rheum Dis. 2005;6411:1663-1665. [CrossRef] [PubMed]
 
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