BMJ Case Reports 2017; doi:10.1136/bcr-2017-219944
  • Unexpected outcome (positive or negative) including adverse drug reactions

Is FCH PET able to identify foci of infection superiorly to FDG PET?

  1. Roslyn Francis2
  1. 1Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands, Australia
  2. 2Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
  1. Correspondence to Dr Liesel Elisabeth Hardy, lieselhardy{at}
  • Accepted 17 June 2017
  • Published 14 July 2017


We report a case of a brain abscess identified on fluorine-18 choline (FCH) positron emission tomography (PET) scan, which was not identified on fluorodeoxyglucose (FDG) PET scan. To our knowledge, there are no previous case reports of incidental brain abscess identified by FCH PET imaging. A 51-year-old man, with liver cirrhosis complicated by hepatocellular carcinoma (HCC) was enrolled in a research trial comparing HCC detection in FCH PET versus FDG PET. During the course of the trial, he underwent radiofrequency ablation (RFA) for HCC. A repeat FCH PET scan post-RFA incidentally revealed a 2.5 cm lesion with avid uptake in the left occipital area of the brain. The patient was asymptomatic. MRI suggested this was an abscess. A craniotomy and drainage was performed, with culture of Streptococcus intermedius (S. milleri group) from the thick-walled collection, a causative organism for previous episode of pneumonia. He successfully completed a 6 week course of antibiotics.


  • Contributors LEH collected the results and drafted the report. She is the guarantor. HH drafted and revised the report. MW revised the report. RF analysed and prepared the images and revised the report.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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