WHOLE BODY PET CT SCAN Patient Name: XYZ Date: 02.05.08 Age: 54 years Sex: Male REF: Dr. ABC CT SCAN OF THE VERTEX TO MID THIGH (ORAL & IV CONTRAST) Diagnosis: Non small cell lung carcinoma. FINDINGS: CT Head: The neuroparenchyma is unremarkable without evidence of mass effect, midline shift or abnormal enhancement. The ventricles, sulci and basal cisterns are unremarkable. The calvarium is unremarkable. CT Neck: The nasopharynx, oropharynx, hypopharynx, supraglottic and infraglottic larynx, vocal cords and upper trachea are unremarkable. No significant cervical lymphadenopathy is seen. Bilateral tiny cervical nodes seen in posterior cervical space and level I A/B – radiologically non significant. Both lobes of thyroid show nodular hypodense areas, largest left measuring 1.1 x 1 cm. A tiny calcified density is also seen within it. CT Chest: Heterogeneously hypodense neoplasm showing inhomogeneous enhancement and central diffuse necrotic components is seen involving the left upper lobe anterior segment and measuring approximately 8.9 x 5.5 x 6.9 cm. It extends from the left upper lobar bronchial division, indents the left upper lobar branch of pulmonary artery and is adherent to the mediastinal and anterior subcostal pleura – represents primary malignant neoplasm. Perilesional tiny nodules and atelectatic changes suggestive of adjacent parenchymal infiltration are also seen. Lung parenchymal fibrotic and bronchiectatic changes are seen involving bilateral upper and right middle lobes with significant loss of right lung parenchymal volume. Bilateral apical pleural thickening with granulomas suggestive of prior infective etiology are also seen. Few tiny nodules are also seen scattered within the right upper and middle lobes, largest 4.2 mm (image # 96, of series 3). Contd…. Page 2 No evidence of pleural effusion. Lower trachea and main bronchi are unremarkable. No pericardial effusion is seen. No significant hilar and axillary lymphadenopathy. Few tiny mediastinal nodes, lower pretracheal 0.8 x 0.7 cm (image # 100, series 3), tiny aortopulmonary window nodes (image # 103, series 3) and atleast two subcarinal nodes, largest measuring 1.3 x 1.1 cm are seen. The thoracic aorta and mediastinal vasculature are unremarkable. CT abdomen and pelvis: Liver: Normal in size, shape, outlines and parenchymal attenuation. No focal lesions are identified. The porta hepatis is normal. The intrahepatic portal venous radicals are normal. No evidence of intrahepatic billiary radicular dilatation. The hepatic veins and intrahepatic portion of inferior venacava are normal. Gall bladder: Normal in size, shape and outlines. Peri-cholecystic area is normal. The common bile duct is not dilated. Spleen: Normal in size, shape and attenuation values. The splenic hilum and splenic vein are normal. Pancreas: Normal in size, contour and attenuations values. No evidence of focal mass lesion/pancreatic duct dilatation. Adrenal glands: Adrenals demonstrate nodular contour bilaterally. Kidneys: Both kidneys are normal in size and shape. The renal outlines are normal. No evidence of focal mass lesion/hydronephrosis/ calculi. Both kidneys show cortical cyst, largest in the left kidney measures 4.5 x 3.2 cm. Rest all others is are less than 2 cm. An exophytic left renal cortical cyst is also seen along the antero-lateral subcapsular G.I tract: The stomach is normal in site and size. The duodenum and proximal jejunal loops are normal in caliber. The ileum and ileo–caecal junction are normal. Eccentric thickening of the posterior wall of the proximal 3rd transverse colon is seen extending for approximately 8.2 cm– likely to represent malignant neoplasm ? primary ?? metastatic (image # 173 - 181, series 3). It shows a maximum thickness of 1.5 cm. Contd…. Page 3 There is a 4.6 x 3.3 cm exophytic component of the above mass / lymphnodal mass infiltrating the transverse mesocolon and root of the mesentery (image # 172 - 182, series 3). Perilesional mesenteric fat stranding is also seen. No proximal bowel dilatation. Rest of the colon and rectum are unremarkable. Urinary bladder is well distended. Prostatomegaly with median lobe hypertrophy, 4.3 x 3.9 cm maximum axial dimension. No free fluid, fluid collection or free air. The aorta demonstrates atheromatous calcification without aneurysmal dilatation/dissection. A mesenteric node measuring approximately 1.8 x 1.4 cm (image # 165, series 3) is seen in the superior mesenteric region (SUV – 2.7). Another node supero-anterior to the above measuring 1.3 x 1.2 cm is also seen (image # 161, series 3). Both shows focal FDG uptake – metastatic mesenteric nodes. A tiny calcified granuloma is seen - solitary along the right spermatic cord, Another calcified granuloma is seen in the left gluteal subcutaneous region. Generalized mild osteopenic changes and few tiny bone islands in neck of left femur, right iliac bone and left supra-acetabular region are seen. PET findings: Protocol: With the patient fasting for 6 hours, 10mci of FDG was injected intravenously and whole body 3D PET CT scan was performed. Physiological concentration is seen in the heart, gut, brain, kidneys and bladder. Increased FDG concentration is seen in the following regions SUV based on BSA( Body surface area): Left upper lobe mass : SUV 4.5 Transverse colon eccentric mass: SUV 3.2 Mesenteric metastases: SUV 2.7 Contd…. Page 4 IMPRESSION: PETCT: Metabolically active left upper lobe metabolically active malignant neoplasm with infiltration of adjacent pleura and lung parenchyma. Few mediastinal nodes, largest subcarinal; none showing metabolic activity. Proximal third transverse colon eccentric, metabolically active malignant neoplasm. Atleast two large metabolically active mesenteric metastatic nodes are also seen. Bilateral thyroid nodules, without any metabolic activity. Lung parenchymal fibrotic and bronchiectatic changes. Prostatomegaly with median lobe hypertrophy. Bone islands, radiologically non significant. Bilateral renal cortical cyst. No other significant abnormality. Comments: The above are likely to represent malignant primary from transverse colon with left upper lobe lung metastatic lesion. Suggested review of left upper lobe lung lesion histology. However double primary malignant neoplasms cannot be ruled out.