Korean J Radiol.  2015 Feb;16(1):196-200. 10.3348/kjr.2015.16.1.196.

Charcoal-Induced Granuloma That Mimicked a Nodal Metastasis on Ultrasonography and FDG-PET/CT after Neck Dissection

• Choi JW
• Moon WJ
• Choi N
• Roh HG
• Kim MY
• Kim NR
• Moon SG
• Chung HW
• Lim SD
• Yang JH

• KMID: 2070000
• DOI: http://doi.org/10.3348/kjr.2015.16.1.196

Abstract

Charcoal can be used for preoperative localization of metastatic lymph nodes in the neck. Charcoal remains stable without causing foreign body reactions during as hort period. However, foreign body reactions may develop if charcoal is left in situ for more than 6 months. We reported a case of charcoal granuloma mimicking local recurrence on fluorodeoxyglucose-positron emission tomography/computed tomography and ultrasonography in a 47-year-old woman who had cervical lymph node dissection due to metastatic invasive ductal carcinoma of the breast.

Keyword

Charcoal granuloma; FDG-PET/CT; Ultrasound, Neck

MeSH Terms

Breast Neoplasms/pathology/surgery/therapy
Carcinoma/*pathology/surgery/therapy
Cervix Uteri/pathology/ultrasonography
Charcoal/toxicity
Female
Fluorodeoxyglucose F18/diagnostic use
Granuloma/*diagnosis/pathology
Humans
Lymph Nodes/*surgery/ultrasonography
Lymphatic Metastasis
Middle Aged
Neoplasm Recurrence, Local
Positron-Emission Tomography
Radiopharmaceuticals/diagnostic use
Tomography, X-Ray Computed
Charcoal
Fluorodeoxyglucose F18
Radiopharmaceuticals

Figure

• 

  Fig. 1 US, PET/CT, chest CT and pathologic findings of charcoal-induced granuloma. Preoperative US (A) shows several hypoechoic nodules with well-defined margins (arrows) and one well-defined, isoechoic nodule (broken arrow) with internal high echoic dots in right level IV. These lymph nodes were localized using charcoal and revealed metastatic lymph nodes with perinodal infiltration. Follow-up US at 6 months (B) shows irregularly shaped, hyperechoic nodule measuring 9.8 mm with indistinct margin with adjacent sternocleidomastoid muscle and fat of posterior cervical space (arrows). On 2-year follow-up US for US-guided core biopsy (C), compared to previous US (B), echogenicity of nodule decreased, and posterior acoustic shadowing was prominent (arrows). Six-month, initial follow-up FDG-PET and PET/CT (D) shows hypermetabolic nodule (SUVmax = 4.0) at right level IV (arrow). FDG = fluorodeoxyglucose, PET = positron emission tomography, SUVmax = maximum standardized uptake value, US = ultrasonography. Lesion is still hypermetablic (SUVmax = 4.3) (arrow) on 18-month follow-up FDG-PET and PET/CT (E). Precontrast chest CT (F) acquired at same day shows slightly hyperdense, oval-shaped nodule at lateral aspect of right internal jugular vein (arrow). Postcontrast CT (G) shows no definite enhancement of nodule (arrow). Gross specimen (H) shows black-pigmented soft tissue fragment. Microscopic image (H&E staining, × 300) (I) shows black pigments suggesting charcoal particles (asterisks) surrounded by multinucleared giant cells (arrows) and fibrosis (broken arrow). FDG = fluorodeoxyglucose, PET = positron emission tomography, SUVmax = maximum standardized uptake value, US = ultrasonography

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