This is a time that I forgot both my principles and the basics, and failed to give a proper differential. This elderly Asian patient presented with a short history of breathlessness ( a pacemaker had been fitted in the past). An echo had shown mitral stenosis, but not valvar, more a thickened and constricted mitral ring. We did a CT, below.
Well, we thought, what on earth could produce a constricting mitral annulus. Tumour seemed a possibility, and someone had the bright idea of doing an FDG/PET scan (below).
Well, it was certainly hypermetabolic. It still did not make sense entirely but I assumed that tumour it was, and the team referred the patient to exploratory surgery. Now the basics tell you that infection will give a positive FDG scan, but I gave it only cursory consideration as there was no sign of surrounding oedema. What I forgot was tuberculosis and other more indolent infections. TB it was! Not infrequently a baffling case will turn out to be TB, in any organ system: its always something to raise if you are faced with something atypical.