A Case of Myocardial Ischemia Detected in a Standard Oncological FDG PET/CT Study

Reporting incidental 18F-FDG PET/CT findings that require further evaluation or urgent treatment is critical, as they can have a major impact on a patient's management. Among the possible alert findings, those related to the heart may be the most challenging due to the variety of physiological 18F-FDG uptake in the myocardium in standard PET/CT imaging with 4-6 hours fasting. We report a case of an 84-year-old man with rectosigmoid adenocarcinoma, without known coronary artery disease, who underwent 18F-FDG PET/CT for staging. An incidental striking focal uptake in the left ventricle accompanied by clinical symptoms, prompted further evaluation, which confirmed acute myocardial ischemia.