Incidentally detected grade 3 cystocele on FDG PET/CT in a case of suspected malignancy
A 65-year-old lady presented to our institution with non resolving pneumonia. She had severe cough with expectoration since 2 months, which aggravated over last one month. She also complained of significant weight loss during that period. Posteroanterior chest radiograph showed consolidation involving the lower lobe of left lung, following which she was treated with broad spectrum antibiotics. Since there was no improvement in her symptoms and her radiographic findings, lung malignancy was suspected. She was referred for a whole body 18 Fluoride fluorodeoxyglucose positron emission tomography/computed tomography (18 F FDG PET/CT), for further evaluation of a possible malignant etiology. Maximum Intensity Projection (MIP) images revealed low grade FDG uptake in left lung [-arrowhead], corresponding to the consolidation and ground glass opacification seen on the CT component of the study. Physiological tracer distribution was seen in the heart, brain, liver and urinary bladder. However, a distinct focus of intense FDG uptake was seen inferiorly, separate from the urinary bladder [-arrows]. The intense nature of the FDG concentration was similar to that of urinary tracer accumulation in the bladder. Axial CT images showed that the uptake corresponded to a well defined rounded lesion, which was protruding out from the introitus and had a fluid density -arrow]. Sagittal fused PET/CT images revealed that there was definite communication with the bladder, suggesting the possibility of herniated bladder [-arrows]. Subsequent clinical evaluation confirmed that the intensely tracer concentrating structure at the introitus was a grade 3 cystocele.