Hiatal Hernia Mimics Centrally Necrotic Cancer in the Lung on FDG Positron Emission Tomographic Imaging

Fluorodeoxyglucose (FDG) positron emission tomographic (PET) imaging is playing an increasingly important role in the evaluation of lung nodules and lung cancer. Ring-shaped lesions with intense peripheral FDG activity and central photopenia due to necrosis are frequent findings in patients with cancer. However, not all such FDG activity is due to cancer. The authors report a case with a ring-shaped increase of FDG accumulation in the right lung base, which itself is indistinguishable from necrotic cancer. However, computed tomographic (CT) images revealed a hiatal hernia in the same location. This case demonstrates the importance of the knowledge of anatomic imaging when FDG-PET scans are interpreted.