Tumor thrombosis and bland thrombosis complicating cancer of the left testicle in 18FDG PET/CT

We report the case of a 46-year-old patient with pulmonary embolism complicating thrombosis of the left renal vein and inferior vena cava, which came from a malignant tumor of the left testicle. The case has been elucidated by positron emission tomography with (18)FDG coupled to the CT-scan (PET/CT), performed as part of the etiological assessment of this pulmonary embolism, and anatomical and physiological considerations. The examination revealed (18)FDG uptake in thrombus of the left kidney vein and the inferior vena cava. In view of the anatomy of the left spermatic vein, this finding led to the left testicle, which shows no nuclide uptake but was bathed in a large hydrocele visible on CT images. If several cases of pulmonary embolism or thrombosis of the inferior vena cava revealing a testicular cancer have been described in the literature, there has been no report including (18)FDG PET/CT to the best of our knowledge. This case illustrates the imaging differences between bland and malignant thrombus as a consequence of their pathophysiology. It highlights the contribution of CT images from the PET/CT for the diagnosis. (C) 2012 Elsevier Masson SAS. All rights reserved.