Sixteen year old teenager post heart transplant. EBV +. The exam is requested to rule out PTLD.
High tonsils and adenoid uptake (SUVmax 10.8 in adenoids). Several lymph nodes of varying uptake and size, distributed in both sides and in multiple levels. The larger lymph nodes are near 1 cm with SUVmax 5.
Linear inflammatory sternal uptake following sternotomy. Very mild uptake in small right inferior paratracheal, subcarinal and hilar lymph nodes. Right anterior chest contamination.
Splenomegaly with homogeneous high uptake (SUV max 6.8). Two hypermetabolic gastrohepatic lymph nodes. Very mild uptake in inguinal lymph nodes.
Homogeneous bone marrow activity.
Post-transplant lymphoproliferative disorders (PTLD)
Epstein-Barr virus (EBV) primary infection
Part 1: EBV primary infection
This patient had heart transplantation few months before exam. He was known to be EBV seronegative before transplantation. Because of the clinical and serological findings, he was considered to have primary EBV infection. Based only on the imaging findings we could not differentiate between EBV primary infection (involving Waldeyer’s ring, spleen and two gastro-hepatic lymph nodes) and PTLD.
Few reports demonstrated PET-FDG findings in EBV primary infection. Thomas et al. reported a 17 year old girl (probably immunocompetent) with symptoms of fever, abdominal pain and nausea/vomiting. PET FDG revealed intensely activity in adenoids, bilateral cervical and retroperitoneal lymph nodes and diffusely increased uptake in enlarged spleen.