Clinical History
50 years old lady with a history of left breast ca. She is status post left mastectomy in Mar 08 followed by chemotherapy from Jul till Nov 08. Her CA 15.3 was normal in Jul 09. PET/CT to assess disease status.
Findings
The current study was compared with the previous PET scan of 13 July 2009.
The patient is status post left mastectomy. No abnormal FDG-avid focus is noted in the left anterior chest wall and right breast.
July 2008
September 2009
There are mildly FDG-avid left supraclavicular node, right paratracheal nodes, aortopulmonary window nodes and subcarinal node as well as bilateral hilar nodes of low grade activity which show decline in FDG activity and are more in keeping with resolving nodal disease. For example, the right paratracheal nodes have a maxSUV of 2.9 vs 8.6 previously. No FDG-avid axillary or internal mammary nodes are noted. The previously noted FDG-avid left axillary node and node adjacent to the aortic arch have resolved on PET.
Some of the previously noted lung nodules have resolved. A few residual subcentimeter lung nodules are still present bilaterally but these show decrease in size and are currently most likely too small to be accurately resolved on PET. There are new mildly FDG-avid air-space densities/ consolidation in the right upper lobe, right middle lobe, right lower lobe and left upper lobe which are more likely to be infective in origin. Linear atelectasis is seen in both lower lobes. No pleural effusion or pericardial effusion is present.
No abnormal FDG-avid focus is noted in the cerebral hemispheres or cerebellum.
There are no FDG-avid intra-abdominal or retroperitoneal nodes. Mild fatty change of the liver 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.
Clinical Impression
Some of the previously noted lung nodules have resolved. A few residual subcentimeter lung nodules are still present bilaterally but these show decrease in size and are currently most likely too small to be accurately resolved on PET and are more likely to represent treated metastases.
The new mildly FDG-avid air-space densities/ consolidation in both lungs are more likely to be infective in origin. Nevertheless, follow-up scan to assess for resolution of these changes is recommended following a course of treatment.
The mildly FDG-avid left supraclavicular node and mediastinal nodes as well as the bilateral hilar nodes of low grade activity show decline in FDG activity and are more in keeping with resolving nodal disease. The previously noted FDG-avid left axillary node and node adjacent to the aortic arch have resolved on PET.
There are no new FDG-avid metastatic foci noted elsewhere.
Overall findings indicate good metabolic response to treatment.
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