FDG PET/CT Revealing a Rare Triad of Adrenal, Cardiac, and Central Nervous System Involvement in B-Cell Non-Hodgkin Lymphoma

Adrenal involvement in non-Hodgkin lymphoma is uncommon and is recognized as a marker of adverse outcomes and of tropism for the central nervous system (CNS). We report a 22-year-old man who presented with fever, weight loss, and abdominal pain, in whom whole-body 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) demonstrated a large FDG-avid right suprarenal mass with contralateral adrenal involvement, 10 metabolically active cerebral lesions with mass effect, and FDG-avid deposits in the right atrium and left ventricle, together with peritoneal, soft tissue, and osseous disease. Biopsy of a retroperitoneal lymph node confirmed aggressive B-cell non-Hodgkin lymphoma. Imaging raised the enumerated extranodal count from two to at least six, establishing Ann Arbor stage IVB disease with an International Prognostic Index (IPI) of 4 and a CNS-IPI of 5. The patient died before treatment could be initiated. To our knowledge, this is the first imaging documentation of synchronous adrenal, cardiac, and CNS involvement in aggressive B-cell lymphoma.