A Rare Case of Hibernoma Occasionally Identified by 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in a Patient with Lung Cancer

Hibernoma is a benign tumor arising from brown fat tissue. Conventional imaging techniques are not able to differentiate it from other benign lesions or malignant fatty tumors. We report the case of a 73-year-old patient who underwent a thorax computed tomography (CT) and was then referred to our department for metabolic assessment of a solitary lung nodule. An F18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) scan was performed and demonstrated, in addition, a highly metabolic fat-containing lesion mimicking a malignant fatty tumor in the left great pectoralis muscle. The lesion was excised and resulted to be a hibernoma. This case shows that hibernoma can appear as a malignant-like lesion on 18F-FDG-PET/CT scan as per other imaging techniques, and the grade of FDG uptake does not accurately reflect malignancy in this fat-containing tumor. However, 18F-FDG-PET/CT with its whole-body scanning capability may represent a useful imaging tool in identifying, in the course of an imaging study for oncological evaluation, additional incidental findings such as benign fat-containing lesions that may require a surgical approach.