80多岁晚期前列腺癌患者中18F-FDG PET/CT检出迟发症状的平衡型双主动脉弓：一例病例报告

文献信息

中文摘要

理由： 双主动脉弓（DAA）是一种罕见的先天性血管异常，通常在婴儿期诊断。成人或老年人发病不常见，平衡型DAA相对罕见。在肿瘤学18F-氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）上，纵隔管状结构伴有血池水平的FDG摄取可能为血管异常提供重要线索。
患者关注： 一名80岁男性，活检证实为晚期前列腺癌，接受18F-FDG PET/CT进行全身分期。他有排尿困难和背痛超过1年，伴有轻度间歇性吞咽不适。
诊断： PET/CT显示多发性FDG高摄取骨转移。轴位和冠状位PET/CT图像显示双侧主动脉弓组件邻近气管食管区域，FDG摄取相当于主动脉血池。三维容积渲染证实为平衡型DAA，形成完整的血管环。
干预： 未进行针对DAA的干预。未进一步行CT血管造影，因为PET/CT表现典型，进一步的血管成像不太可能改变管理。
结果： 建议保守治疗。在PET/CT后约6个月，患者间歇性吞咽不适保持稳定，未进行针对DAA的干预。
教训： 平衡型DAA可能在肿瘤学18F-FDG PET/CT上被偶然发现。识别与主动脉系统连续且显示血池水平FDG摄取的管状纵隔结构可能有助于避免误判为恶性纵隔疾病。

英文摘要

RATIONALE: Double aortic arch (DAA) is a rare congenital vascular anomaly usually diagnosed in infancy. Adult or elderly presentation is uncommon, and balanced-type DAA is relatively rare. On oncologic 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT), a mediastinal tubular structure with blood-pool-level FDG uptake may provide an important clue to a vascular anomaly.
PATIENT CONCERNS: An 80-year-old man with biopsy-proven advanced prostate cancer underwent 18F-FDG PET/CT for systemic staging. He had dysuria and back pain for more than 1 year, with mild intermittent swallowing discomfort.
DIAGNOSES: PET/CT showed multiple FDG-avid bone metastases. Axial and coronal PET/CT images demonstrated bilateral aortic arch components adjacent to the tracheoesophageal region, with FDG uptake equivalent to the aortic blood pool. Three-dimensional volume rendering confirmed balanced-type DAA forming a complete vascular ring.
INTERVENTIONS: No DAA-directed intervention was performed. Additional CT angiography was not pursued because the PET/CT findings were characteristic and further vascular imaging was unlikely to alter management.
OUTCOMES: Conservative management was recommended. At approximately 6 months after PET/CT, the patient's intermittent swallowing discomfort remained stable, and no DAA-directed intervention was performed.
LESSONS: Balanced-type DAA may be incidentally detected on oncologic 18F-FDG PET/CT. Recognition of a tubular mediastinal structure continuous with the aortic system and showing blood-pool-level FDG uptake may help avoid misinterpretation as malignant mediastinal disease.