Isolated metastatic adrenal involvement with colon cancer and FDG coincidence detection imaging

A 65-year-old man was treated initially for a localized rectal carcinoma in 1998. One year later, his serum carcinoembryonic antigen (CEA) level increased. Results of a colonoscopy and computed tomography (CT) of the lung were negative. Abdominal CT showed a right suprarenal mass, suggestive of a metastatic tumor. Fluorodeoxyglucose (FDG)-coincidence detection (CDET) imaging showed an isolated right suprarenal focus of uptake. Adrenalectomy confirmed the diagnosis. F-18 FDG can be used to determine whether tumors are resectable in patients with elevated CEA levels. The CT scan showed an isolated adrenal tumor, whereas FDG-CDET imaging characterized this enlargement as probably malignant with no other sites of pathologic uptake.