Unilateral Lateral Rectus Paralysis Showing Incomplete 'V' Sign’ on 18F-FDG PET/CT

Extraocular muscles show physiologic radiotracer uptake on F-FDG PET/CT as is encountered in most routine scans. Certain pathologies can cause palsy of one or more of the extraocular muscles, leading to hypometabolism on F-FDG PET/CT. We present a case with a classical finding of unilateral hypometabolism of the lateral rectus muscle, disrupting the "V" sign formed due to physiologic uptake. The patient had presented with the complaint of diplopia and was being evaluated further to rule out the possibility of inflammatory/granulomatous infectious etiopathogenesis leading to compression of the abducens nerve resulting in lateral rectus palsy.