Incidental Finding of Sinus/Venous Thrombosis on PET/CT

Figure 1

Figures: a) Maximum intensity projection (MIP) of the 18F-FDG-PET/CT with long-segment hypermetabolism of the superior sagittal sinus, both transverse sinuses, the right sigmoid sinus, and the adjacent right jugular vein (arrows). Cervical lymphadenopathy typical of lymphoma was also observed (asterisks). b) Axial cranial CT angiography showing absence of contrast filling in the right transverse sinus and the confluence of sinuses, as well as interruption of contrast filling in the left transverse sinus (arrow).

A patient in their 70s was referred to our Department of Nuclear Medicine for an 18F-FDG-PET/CT (18F-fluorodeoxyglucose positron emission tomography and computed tomography). A lymphoproliferative disease was suspected, and the question of disease spread and localization arose for diagnostic lymph node excision. In addition to FDG-positive lymphadenopathy typical of lymphoma, native PET/CT revealed intense, long-segment FDG hypermetabolism of multiple cerebral sinuses and the right jugular vein (Figure a). Further diagnostic work-up was performed using venous cranial CT angiography (CTA), which confirmed the suspected sinus/venous thrombosis (SVT) (Figure b). The patient exhibited no neurological symptoms. This case illustrates an unusual finding on PET/CT. The location of the PET finding corresponded to the occluded vascular segments on CTA. The incidence of concomitant cancer in the setting of SVT is 6.5%; these patients are often older and less likely to present with symptoms such as headache. Oral anticoagulation with a direct oral anticoagulant was initiated.

Acknowledgment: We would like to thank Mathias Niepel of the Radiology Institute at St. Josef’s Hospital in Potsdam for interpreting the CTA results.

Johannes Gerber, Klinik für Nuklearmedizinische Diagnostik und Therapie, Klinikum Ernst-von-Bergmann, Potsdam, [e-mail]

Anton Reuter, Klinik für Innere Medizin, Alexianer St. Josefs-Krankenhaus Potsdam

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Gerber J, Reuter A: Incidental finding of sinus/venous thrombosis on PET/CT.
Dtsch Arztebl Int 2026; 123: 309. DOI: 10.3238/arztebl.m2025.0202