Aschoff, Philip

Pfannenberg, Christina

Werner, Matthias

Öksüz, Mehmet

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IMAGE OF THE MONTH18F-FDG PET/CT for the diagnosis of sarcoidosis in a patientwith bilateral inflammatory involvement of the parotidand lacrimal glands (panda sign) and bilateral hilarand mediastinal lymphadenopathy (lambda sign)Mehmet Ö. Öksüz & Matthias K. Werner &Philip Aschoff & Christina PfannenbergReceived: 23 August 2010 /Accepted: 8 November 2010 /Published online: 6 January 2011# Springer-Verlag 2010A 43-year-old man was hospitalized for Sjögren’s syndromewhichwas suspected to be of paraneoplastic aetiology. 18F-FDGPET/CT revealed grossly enlarged lacrimal (a) and parotidglands (b) with significantly increased FDG uptake while thesubmandibular glands (c) were only minimally enlarged withfaint FDG uptake. Furthermore, hypermetabolic intrathoraciclymphadenopathy was detected with a typical lambda appear-ance (h) involving right paratracheal (e), left paratracheal andaortopulmonary window lymph nodes (f) of the mediastinumand bihilar lymph nodes (g). The imaging findings weresuggestive of sarcoidosis and bronchoscopic evaluation withbiopsy was proposed. Histopathology of a transbronchialbiopsy specimen confirmed the diagnosis of sarcoidosis.In 1990 Sulavik et al. first described the panda sign, i.e.normal accumulation of the radionuclide (67Ga-citrate) in thenasopharynx combined with increased symmetric accumula-tion in the parotid and lacrimal glands, giving the impressionof the mottled colouring of the giant panda [1–3]. Intratho-racic lymphadenopathy typically manifests as bilateral hilaradenopathy with predominantly right paratracheal adenopathy,referred to as the lambda appearance [4].With 18F-FDG PET/CT the appearance of hypermetabolicmediastinal and bihilar lymphadenopathy in sarcoidosis iscomparable to the lambda sign of 67Ga-citrate scintigraphy[5]. Bilateral inflammatory involvement of the parotid andlacrimal glands is also present, resulting in an increased FDGuptake, although the typical panda appearance is partiallyobscured due to the physiologic FDG avidity of the brain (d).The finding of typical lambda and panda patternssupports the diagnosis of sarcoidosis and reinforces theindication to perform an appropriate biopsy.Conflicts of interest None.References1. Sulavik SB, Spencer RP, Weed DA, Shapiro HR, Shiue ST,Castriotta RJ. Recognition of distinctive patterns of gallium-67distribution in sarcoidosis. J Nucl Med 1990;31:1909–14.2. Kurdziel KA. The panda sign. Radiology 2000;215:884–5.3. Sulavik SB, Spencer RP, Castriotta RJ. Panda sign—avid andsymmetrical radiogallium accumulation in the lacrimal and parotidglands. Semin Nucl Med 1991;21:339–40.4. Miller BH, Rosado-de-Christenson ML, McAdams HP, FishbackNF. Thoracic sarcoidosis: radiologic-pathologic correlation. Radio-graphics 1995;15:421–37.5. Krüger S, Buck AK, Mottaghy FM, Pauls S, Schelzig H, HombachV, et al. Use of integrated FDG-PET/CT in sarcoidosis. ClinImaging 2008;32:269–73.ABCDCBAACBHE F GM. Ö. Öksüz (*)Department of Radiology and Nuclear Medicine,Basel University Hospital, Petersgraben 4,4031 Basel, Switzerlande-mail: oeksuezm@uhbs.chM. Ö. ÖksüzDepartment of Nuclear Medicine,Tübingen University Hospital, Otfried-Müller-Strasse 14,72076 Tübingen, GermanyM. K. Werner : P. Aschoff :C. PfannenbergDepartment of Diagnostic and Interventional Radiology,Tübingen University Hospital, Hoppe-Seyler-Strasse 3,72076 Tübingen, GermanyEur J Nucl Med Mol Imaging (2011) 38:603DOI 10.1007/s00259-010-1679-7

18F-FDG PET/CT for the diagnosis of sarcoidosis in a patient with bilateral inflammatory involvement of the parotid and lacrimal glands (panda sign) and bilateral hilar and mediastinal lymphadenopathy (lambda sign)

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18F-FDG PET/CT for the diagnosis of sarcoidosis in a patient with bilateral inflammatory involvement of the parotid and lacrimal glands (panda sign) and bilateral hilar and mediastinal lymphadenopathy (lambda sign)

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