Author/Authors :
Panda, Ananya Departments of Radiology - Mayo Clinic - Rochester, USA , McCarthy, Michael R Departments of Pathology - Mayo Clinic - Minnesota, USA , Murray, Joseph A Departments of Gastroenterology - Mayo Clinic, Minnesota, USA , Sharain, Rosalind F Departments of Pathology - Mayo Clinic - Minnesota, USA , Shi, Min Departments of Pathology - Mayo Clinic - Minnesota, USA , Kendi, Ayse Tuba Departments of Radiology - Mayo Clinic - Rochester, USA
Abstract :
Celiac disease is an immune-mediated disorder triggered by hypersensitivity to gluten occurring in genetically susceptible individuals. A high-index of suspicion is needed for diagnosis as patients can be asymptomatic or present with atypical symptoms or extra-intestinal manifestations. Typical 18F-Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET)/Computed Tomography (CT) gastrointestinal manifestations of celiac disease include increased multifocal or diffuse jejunal and ileal uptake; focal duodenal uptake is less common. Splenomegaly with increased splenic FDG uptake is also uncommon in celiac disease in the absence of portal hypertension; small-sized spleen and functional hyposplenism are more typical. We report a case of celiac disease diagnosed after PET/CT showed FDG uptake in the duodenum and enlarged spleen. Follow-up after gluten-free diet showed complete metabolic resolution and regression of splenomegaly. The combination of focal bowel and splenic uptake is unusual in celiac disease and may be mistaken for a lymphoproliferative disorder. Awareness of this entity may avoid misdiagnosis and guide appropriate management.
Keywords :
Celiac disease , Splenomegaly , 18F-FDG PET/CT , Incidental bowel uptake , Lymphoma
