FDG PET in primary effusion lymphoma (PEL) of the pericardium

We present the FDG PET images of a 49-year-old male AIDS patient with a history of Kaposi sarcoma who presented with increasing shortness of breath. The computed tomography (CT) scan of the chest showed a massive pericardial effusion, which was tapped. There was no other clinical or radiologic evidence (otherwise negative CT scan of the chest, abdomen, and pelvis) of lymphoma. A whole-body PET scan was performed after the intravenous administration of 11.0 mCi of F-18 FDG. The images showed physiological uptake in the myocardium, a photopenic defect around the heart corresponding to the pericardial effusion, lined by a hypermetabolic pericardium, consistent with neoplastic involvement. There was no other evidence of active neoplastic disease. Histopathologic analysis of the pericardial fluid showed findings characteristic of primary effusion lymphoma (PEL) and chemotherapy was started.