Clinical History
52 years old gentleman with anterior mediastinal mass and elevated CA 19.9. PET/CT for diagnosis and staging.
Findings
There is a hypermetabolic FDG avid lobulated anterior mediastinal mass present (SUVmax of 4.2). It measures approximately 7.5 x 5.3 cm in maximum axial dimensions. It does not appear to invade the adjacent vascular structures.
No FDG-avid mediastinal, axillary or supraclavicular nodes are noted. The mildly FDG avid bilateral hilar nodes are more in keeping with reactive nodes.
No FDG-avid focus is seen in the lungs. The subcentimeter nodules in the right middle lobe and lingula are too small to be accurately resolved on PET and are indeterminate on CT. the other airspace densities in the right middle lobe are more likely to be infective in origin. Mild bronchiectatic changes are present, more evident in the right upper and middle lobes. There are two pleural nodules with low grade FDG avidity in the left hemithorax posteriorly and along the diaphragmatic surface (mis-registetered due to respiration). No pleural or pericardial effusion is noted.
A dedicated brain study was not performed. However no focal area of abnormal increased metabolic activity is detected to suggest presence of FDG avid metastatic disease in either of the cerebral hemispheres or cerebellum.
There are no FDG-avid intra-abdominal, retroperitoneal or pelvic nodes. The non FDG-avid subcentimeter para-aortic and bilateral inguinal nodes are more in keeping with reactive nodes.
The discrete focus of mildly increased FDG avidity in the hepatic flexure is most likely due to diverticulitis. FDG avid diverticuli are also seen in the ascending colon, transverse colon, descending colon and sigmoid colon.
No abnormal FDG-avid focus is noted in the liver, spleen, pancreas or adrenal glands.
The bone marrow shows normal physiological distribution of FDG activity.
Clinical Impression
FDG avid lobulated anterior mediastinal mass is detected. Histological correlation is recommended.
Two pleural nodules with low grade avidity in the left hemithorax are suspicious but not definitive of metastases.
No other FDG avid focus of malignancy is detected.
|
