Limitations of 18F-FDG PET/CT in detecting direct bronchial metastasis from esophageal squamous cell carcinoma: A case report.

Esophageal cancers predominantly metastasize through direct invasion, lymphatic dissemination, or hematogenous spread. Frequent metastatic locations comprise the liver, lymph nodes, lungs, and bones. However, direct bronchial metastases are extremely rare. We report a case of a 50-year-old male diagnosed with esophageal squamous cell carcinoma who received neoadjuvant chemoradiotherapy and subsequent esophagectomy with gastric pull-up reconstruction. Two years after surgery, follow-up imaging indicated suspicious bronchial lesion. On 18F-FDG PET/CT, the bronchial lesion exhibited only mild 18F-FDG uptake, which may underestimate its malignancy. Histopathological assessment verified metastatic squamous cell carcinoma, congruent with the primary esophageal tumor. This case illustrates the diagnostic limitations of 18F-FDG PET/CT in specific situations and emphasizes the necessity of incorporating clinical, endoscopic, and pathological findings in intricate cases.