Positive 18 F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography 20 Years after Talc Pleurodesis

Our plain-English summary of Positive 18 F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography 20 Years after Talc Pleurodesis, by S.A. Bhupathy, T.V. Huynh (World Journal of Nuclear Medicine, 2022).

The study

• Authors: S.A. Bhupathy, T.V. Huynh
• Journal: World Journal of Nuclear Medicine
• Published: 2022;21(4):325-328
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Talc pleurodesis, a frequently performed procedure for refractory pneumothorax or pleural effusion, induces chronic granulomatous inflammation. It can present years later with pleural thickening and markedly increased uptake on positron emission tomography/computed tomography (PET/CT), mimicking the presentation of malignancies. We present the case of a 63-year-old female with positive 18 F-fluorodeoxyglucose PET/CT 20 years after talc pleurodesis. Malignancy such as mesothelioma could not initially be ruled out. CT-guided biopsy confirmed an extensive foreign-body giant-cell reaction consistent with talc-related inflammatory change. This case highlights the need for the consideration of talcoma in the differential diagnosis of patients who undergo talc pleurodesis, and is unique in the significant timespan of 20 years between pleurodesis and positive imaging findings.

World Association of Radiopharmaceutical and Molecular Therapy (WARMTH). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).

In plain English

This case report described one patient, a 63-year-old woman. Twenty years earlier the patient had been treated for a spontaneous pneumothorax (collapsed lung) with talc pleurodesis, a procedure that places talc in the chest lining to seal it. The patient had a history of cigarette smoking and no known occupational asbestos exposure, and came to hospital with right-sided chest pain. CT scans showed nodular thickening of the pleura (the lining around the lung) with calcifications, unchanged on a repeat scan 6 months later. A PET/CT scan 8 months after the first visit showed high uptake of the tracer, with a maximum standardized uptake value of 17. Because malignant mesothelioma or cancer spread to the pleura could not be excluded, a CT-guided biopsy was taken from a nodule in the chest wall. It showed a foreign-body giant-cell reaction consistent with talc-related inflammation. The pleura itself was not biopsied, and no follow-up imaging was available. The authors concluded that radiologists should consider talcoma, a talc-related inflammatory mass, in patients who have had talc pleurodesis.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: one 63-year-old woman with a history of spontaneous pneumothorax treated with talc pleurodesis 20 years earlier, cigarette smoking, and no known occupational asbestos exposure; she presented with right-sided chest pain
• Exposure: talc pleurodesis performed 20 years before presentation; no known history of prior occupational exposure to asbestos
• Main results:
  • Initial chest CT showed pleuroparenchymal scarring, emphysematous changes, and nodular pleural thickening with calcifications
  • A repeat chest CT 6 months later showed pleural thickening unchanged from the earlier imaging, plus a nodular density extending into the chest-wall tissue
  • PET/CT 8 months after the first visit showed significant FDG uptake, maximum standardized uptake value 17, in the thickened right pleura and the chest-wall component, which raised concern for malignancy
  • The biopsy was taken from the posterolateral chest wall, not the pleura, to minimize risk to the patient
  • Pathology showed an extensive foreign-body giant-cell reaction consistent with talc-related inflammatory changes (talcoma)
  • Pleural biopsy was not performed, and no follow-up imaging was available
• The authors' conclusion: The authors concluded that radiologists should consider talcoma in the differential diagnosis of patients who have had talc pleurodesis, especially patients with no known risk factors for mesothelioma or pleural metastasis

Topics

Medical terms in this study, explained in our Lexicon: Talc Pleurodesis, Pneumothorax, Pleural Effusion, Inflammation, Pleural Thickening, Mesothelioma, Biopsy, Talc.

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