Clinical History
Case of newly diagnosed ca left lung for staging with PET/CT.
Findings
A large hypermetabolic 54 x 48mm lung mass (maxSUV 14.7) is noted in the left upper lobe which is occluding the left upper lobe bronchus resulting in distal atelectasis. The mass has invaded the mediastinum and is contiguous with a FDG-avid mass of matted nodes in the left hilar region, aortopulmonary window and left lower paratracheal region. It is also encasing the left main pulmonary artery.
No FDG-avid focus or nodule is seen in the right lung. No pleural effusion or pericardial effusion is noted.
The other non FDG-avid subcentimeter right paratracheal nodes are more in keeping with reactive nodes. No FDG-avid supraclavicular nodes are seen.
A dedicated brain study was not performed. However no abnormal FDG avid focus is seen in the cerebral hemispheres or cerebellum. The diffuse mildly increased bilateral parotid and submandibular glandular activity is more likely to be physiological in origin. A mucus retention cyst is seen within the right maxillary sinus.
There are no FDG-avid intra-abdominal or retroperitoneal nodes.
A moderately FDG-avid 9mm focus is seen in the left adrenal gland (maxSUV 3.4). No abnormal FDG-avid focus is noted in the liver, spleen, pancreas or right adrenal gland. Bilateral non FDG-avid renal cysts are present.
A FDG-avid focus is noted in T8 vertebra. No other FDG-avid skeletal foci are seen elsewhere.
Clinical Impression
The large hypermetabolic left lung mass is compatible with a primary lung malignancy. The mass has invaded the mediastinum and is contiguous with a FDG-avid mass of matted nodes in the left hilar region, aortopulmonary window and left lower paratracheal region.
The FDG-avid focus in the left adrenal gland and T8 vertebra are suggestive of metastases.
There are no other FDG-avid metastatic foci noted elsewhere.
PET staging is T4N2M1.
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