Hepatic Vascular Shunts Mimicking Malignant Lesions on 18F-FDG PET/CT Imaging: Interpretation Pitfall in the Background of Cirrhotic Liver

A 44-year-old female presented with recent history of ischemic strokes and hypercoagulability and chronic alcoholic cirrhosis. ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography was performed during the workup for vasculitis. PET features of vasculitis were not identified, but liver showed multiple hepatic FDG avid foci, concerning for malignant or metastatic disease in the background of cirrhosis of liver. To characterize these lesions, liver magnetic resonance imaging was subsequently performed which revealed hepatic vascular shunts corresponding to the sites of the FDG avid foci. This case highlights potential interpretation n pitfall arising due to FDG avidity in the vascular shunts resembling malignant or metastatic lesions.