Clinical History
17 year old boy with EBV-associated T-cell lymphoproliferative disease/lymphoma involving the nasopharynx and nodes on either side of the diaphragm. He also has a past history of autoimmune hepatitis. He has been on Dexamethasone since Jul 09. PET/CT to assess disease status.
Findings
The current study was compared with the previous PET scan of 7 July 2009.
The previously noted FDG-avid nodes above the diaphragm have resolved on PET except for bilateral upper jugular/cervical nodes of low grade activity that show decrease in FDG activity (maxSUV 2.0 vs 5.9 previously for the left jugular nodes). Currently, the correlative CT shows non FDG-avid small residual bilateral cervical nodes, bilateral submandibular nodes, nodes adjacent to the aortic arch, right paratracheal node, left lower paratracheal node, subcarinal nodes and bilateral axillary nodes that are more in keeping with treated nodes.
July 2009
September 2009
Below the diaphragm, the majority of the previously noted FDG-avid nodes have also resolved on PET. A few residual mildly FDG-avid mesenteric nodes are still present but these show decrease in FDG activity (maxSUV 3.0 vs 3.9 previously). The non FDG-avid bilateral inguinal nodes are more in keeping with treated nodes.
The mildly FDG-avid focus in the roof of the nasopharynx shows decline in FDG activity (maxSUV 2.5 vs 3.6 previously). The symmetrical mildly increased palatine tonsillar activity could still be physiological in origin.
There is opacification of the left maxillary sinus and this is associated with low grade activity which is more in keeping with sinusitis. The rest of the paranasal sinuses and mastoids are clear.
The previously noted subcentimeter lung nodules in right upper lobe and right middle lobe have resolved on PET. No abnormal FDG-avid focus or nodule is seen in the lungs. No pleural or pericardial effusion is noted.
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
Many of the previously noted FDG-avid nodes above and below the diaphragm have resolved on PET. The bilateral upper jugular/cervical nodes of low grade activity seen currently show decrease in activity. A few residual mildly FDG-avid mesenteric nodes are still present but these also show decrease in FDG activity
The mildly FDG-avid focus in the roof of the nasopharynx shows decline in FDG activity
The previously noted splenic FDG activity has resolved.
Overall findings indicate good metabolic response to treatment.
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