Christophe Deroose

An unusual presentation of a more common disease entity

A 66-year-old, male patient with a 10-pack-year history of smoking was referred to the internal medicine consultation because of a 4-week history of fatigue, weakness, intermittent low-grade fever, appetite and weight loss, and a mild dry cough. His previous history was unremarkable and his physical examination was normal. Routine laboratory screening revealed leukocytosis (11.08×109 leukocytes per L), elevated C-reactive protein (72.1u2005mg⋅L−1) and erythrocyte sedimentation rate 57u2005mm⋅h−1. Analyses for rheumatoid factor, antinuclear antibodies, and cytoplasmic and perinuclear anti-neutrophil cytoplasmic antibodies were all negative. Pulmonary function tests (static and dynamic volumes, flow–volume curve, and lung diffusion capacity) were within the predictive values. Chest radiography demonstrated bilateral hilar enlargement. The patient subsequently underwent a computed tomography (CT) scan of the chest (figure 1). Beware unusual presentations of more common disease entities, as in this interactive case report http://ow.ly/qj7f30eVFsp

Hepatic radiation injury mimicking metastasis in distal esophageal cancer

Abstract Introduction: A new hypermetabolic lesion on 18FDG-PET/CT after neo-adjuvant chemoradiotherapy for distal esophageal cancer can be a hepatic metastasis and should be examined carefully before esophagectomy. Case-report: We present a case of acute and nodular radiation-induced injury of the left liver after neo-adjuvant chemoradiotherapy for distal esophageal cancer, which resembles a hepatic metastasis on 18FDG-PET/CT. Acute and nodular radiation hepatitis (RH) can be a potential cause of false-positive findings of malignancy and therefore exclude patients who could benefit from esophagectomy. Conclusion: 18FDG-PET/CT images should therefore carefully be interpreted and compared with the radiation beams, dose distribution and eventually clarified by DW-MR imaging.