Careful evaluation of CT findings of a cardiac viability F-18 FDG PET/CT study leading to detection of esophageal cancer

We present a case of esophageal adenocarcinoma as a follow-up for lesions seen on the computed tomography (CT) portion of a myocardial viability F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT study. A 64-year-old man presented with a history of prior myocardial infarctions, status post percutaneous transluminal coronary angioplasty, and multiple stent placements for viability evaluation. Limited CT images were viewed as part of the interpretation. Two densities, one in the left lower lung, pleural based, and another in the right retrocrural region were identified on CT images with suspicion for pathology. This was a FDG myocardial viability protocol; therefore, the true metabolic activity in these lesions cannot be assessed. For an F-18 FDG PET/CT myocardial viability protocol, glucose loading is desirable to ensure a predominant glucose substrate for the myocardium. However, for a cancer imaging protocol, 4 to 6 hours of fasting is required before FDG injection. After a discussion with the referring physician, further evaluation with whole body F-18 FDG PET/CT was scheduled for a later date, which additionally showed an esophageal lesion.