Clinical History
Case of Hodgkin’s Lymphoma. The patient is status post chemotherapy in 2006. He now presents with recurrent left axillary nodes. PET/CT to assess recurrent disease status.
Findings
There are FDG-avid bilateral retropharyngeal nodes, bilateral cervical/jugular nodes, left supraclavicular nodes, left subpectoral and left axillary nodes (maxSUV 10.6). No FDG-avid mediastinal nodes are seen. The ametabolic right axillary nodes are more in keeping with reactive nodes.
Mildly increased activity is present in the roof of the nasopharynx (maxSUV 4.9). There is also symmetrical bilateral tonsillar activity noted. Mildly FDG-avid bilateral maxillary and ethmoid sinusitis is present. The rest of the paranasal sinuses are clear.
No FDG-avid focus or nodules are noted in the lungs. No pleural or pericardial effusion is seen. Physiological thymic activity is present.
Below the diaphragm, there are mild to moderately FDG avid peri-splenic nodes (maxSUV 10.8), peri-pancreatic nodes, porta-hepatis nodes, pancreatico-duodenal node, peri-SMA node, retrocaval node and mesenteric nodes. The other subcentimeter ametabolic mesenteric nodes, para-aortic nodes, left common iliac node, bilateral external iliac nodes and bilateral inguinal nodes are more in keeping with reactive nodes.
A 12mm mildly FDG-avid focus is noted in the superior aspect of the spleen (maxSUV 2.8).
No abnormal FDG-avid focus is detected in the liver, pancreas and adrenal glands.
The bone marrow shows physiological distribution of FDG activity.
Clinical Impression
There is FDG-avid nodal disease seen above and below the diaphragm as described.
The increased nasopharyngeal activity and the symmetrical bilateral tonsillar activity could still be physiological in origin rather than represent sites of disease involvement.
The small FDG-avid splenic focus is suspicious of extra-nodal disease involvement.
There is no other FDG-avid extra-nodal focus of disease noted elsewhere.
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