FDG-PET in a myocardial tuberculoma

An 88-year-old woman was admitted for syncope andbradycardia. She complained of recent fatigue and weightloss. After insertion of a pacemaker device, the clinicalcourse was complicated by fever and a seizure. Eventually,we found that a multivisceral culture-positive tuberculousreactivation was likely to account for these symptoms.Radiological workup including 18-fluorodeoxyglucose-positron emission tomography (FDG-PET) yielded amyocardial tuberculoma (Figure1). Myocardial involve-ment is rare compared with the classical pericarditis indisseminated tuberculosis [1], but it may have specific pre-sentations like syncope, palpitations or cardiac failure. Todiagnose disseminated tuberculosis, FDG-PET can beuseful when culture or histopathology is difficult orimpossible [2]. It is a promising technique for therapeuticmonitoring, as it may guide early interventions [3]. Thepatient was treated medically with antituberculous therapyfor 12 months. She was alive 24 months later and the onlysequela was a complete atrioventricular block