Clinical History
60 years old lady with recent excision of malignant melanoma of right sole. PET/CT for post-surgical staging.
Findings
There is evidence of recent surgery of right sole. The low grade to mildly FDG avid focus in the right sole is more in keeping with post-surgical inflammatory changes. No FDG avid popliteal, inguinal, pelvic, retroperitoneal or intra-abdominal nodes are detected. The non FDG-avid subcentimeter bilateral inguinal nodes are more in keeping with reactive nodes.
Fatty liver change is present. There is evidence of previous cholecystectomy. No abnormal FDG-avid focus is seen in the liver, spleen, pancreas or adrenal glands. There is mass of negligible to low grade activity arising from the posterior aspect of the uterus, in keeping with fibroid.
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 is asymmetrical mildly increased FDG avidity in the left fossa of Rosenmuller of the nasopharynx and this is also associated with asymmetry of the post-nasal space on the CT (SUVmax of 3.9).
There are tiny subcentimeter mildly FDG avid bilateral level II cervical/jugular nodes present (SUVmax of 3.2 for the left cervical nodes). The non FDG-avid subcentimeter bilateral axillary nodes are more in keeping with reactive nodes. No FDG-avid hilar, mediastinal or supraclavicular nodes are noted.
No FDG-avid focus or nodule is seen in the lungs. Mild scarring is present in both lungs. No pleural or pericardial effusion is noted.
The bone marrow shows normal physiological distribution of FDG activity.
Clinical Impression
The mildly FDG avid focus in the right sole is more in keeping with recent post-surgical changes.
The asymmetrical mildly increased FDG avidity in the left fossa of Rosenmuller of the nasopharynx requires further ENT evaluation to exclude a pathological process.
The mildly FDG-avid subcentimeter bilateral level II jugular/cervical nodes could still be inflammatory in origin in the absence of a definite site of primary malignancy in the head and neck region. However, follow-up is recommended.
No FDG avid metastatic disease is detected in the rest of the scan.
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