Clinical History
71 years old lady with a history of left breast ca. She is status post left mastectomy in Sep 06 followed by radiotherapy in 2006 and chemotherapy till Apr 07. PET/CT to assess disease status.
Findings
The patient is status post left mastectomy. No abnormal FDG-avid focus is noted in the left anterior chest wall and right breast.
No FDG-avid axillary, internal mammary, supraclavicular or mediastinal nodes are noted. The non FDG-avid subcentimeter right paratracheal nodes and superior mediastinal nodes as well as the subcentimeter bilateral jugular/cervical nodes of negligible to low grade activity are more in keeping with reactive nodes. The non FDG-avid calcified right hilar node and precarinal node are most likely granulomatous in origin.
No FDG-avid focus is seen in the lungs. A subcentimeter calcified granuloma is noted in the right upper lobe. Scarring is seen in the left lung apex, left upper lobe and left lingular segment anteriorly. No pleural effusion or pericardial effusion is noted.
The symmetrical mildly increased bilateral nasopharyngeal activity is more likely to be physiological or inflammatory in origin. The diffuse mildly increased activity in both thyroid lobes could be related to thyroiditis. No abnormal FDG-avid focus is noted in the cerebral hemispheres or cerebellum.
The diffuse mildly increased activity along the caecum, ascending colon and small bowel loops within the pelvis is more in keeping with physiological bowel uptake. In addition, a discrete moderately FDG-avid focus is noted in the anorectal region (maxSUV 7.5). There are no FDG-avid intra-abdominal or retroperitoneal nodes. Biliary sludge is seen. No abnormal FDG-avid focus is noted in the liver, spleen, pancreas, adrenal glands or uterus.
The bone marrow shows normal physiological distribution of FDG activity. The mildly increased right glenohumeral joint activity is most likely inflammatory in origin.
Clinical Impression
The discrete moderately FDG-avid focus in the anorectal region is an incidental finding and could be inflammatory or physiological in origin but clinical evaluation of the area is suggested.
There is no scan evidence of FDG-avid recurrent malignancy from breast ca.
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