Wk 1, Case 5 - Review

Please note: Items with dashed lines (--) are information withheld as it is not relevant for you to arrive at the correct findings and impression for the report and/or it was withheld for privacy information. The items were left in to show you the typical information documented in a PET report.

Clinical Indication:
18-year-old male presented with a large mediastinal mass, status right VATS with mediastinal mass biopsy revealing diffuse large B-cell lymphoma. PET/CT performed for initial staging and treatment planning.

Technique:
Preparation: Last oral intake (except water) on ----- at ----- AM/PM.
Diabetic: -----.
Blood glucose at time of FDG administration: --- mg/dL.
Radiopharmaceutical: ----- mCi of F-18 FDG administered IV at --- at AM/PM.
Incubation interval: -- minutes.
Oral contrast: ----.
Positioning: Arms raised.
PET/CT scanner: -------.
PET/CT acquisition: Vertex-to-mid-thighs.
Standardized uptake value (SUV): Corrected for ------.
CT: Low-dose, non-breath-hold, without intravenous contrast.
TOTAL DLP (Dose Length Product): -- mGy cm.

Comparison/Correlation:
No prior PET/CT comparison. No correlative imaging.

Findings:
Technical quality: Diagnostic.
Measurements: Unless otherwise specified, all SUVs refer to maximum value in the target.
Mean SUV liver: ---.


Head and Neck:
No suspicious hypermetabolic lesions in the head or neck.
No suspicious hypermetabolic cervical adenopathy.
Unremarkable thyroid gland.


Chest:
Large intensely hypermetabolic centrally necrotic anterior mediastinal mass with invasion of the pericardium and adjacent middle lobe lung parenchyma, with maximum SUV 19.0, measuring approximately 10.6 x 7.4 cm.
The mediastinal mass is causing narrowing of the medial right upper and middle lobes bronchi with associated collapse of the right upper and middle lobe and small non-FDG-avid ground-glass opacities in the aerated right upper lobe.
Few additional hypermetabolic paratracheal and para-esophageal lymph nodes. Examples are:

10 x 7 mm right upper paratracheal node, maximum SUV 3.6.
11 x 10 mm para-esophageal lymph node, maximum SUV 11.6.
Small to moderate non-FDG avid right pleural effusion with associated compressive atelectasis of the dependent right lung.
No left pleural effusion.


Abdomen and Pelvis:
No suspicious hypermetabolic lesions in the abdomen or pelvis.
Solid Abdominal Organs:
No suspicious focal hypermetabolic activity in the liver significantly greater than the heterogeneous physiologic uptake.
Unremarkable non-contrast appearance of the liver.
Normal gallbladder.
No hydronephrosis.
Unremarkable spleen.
No suspicious adrenal masses.
No suspicious pancreatic findings.


GI Tract/Mesentery/Peritoneum:
Physiologic bowel activity, without suspicious focal FDG uptake.
The large and small bowel appear normal in caliber.
No suspicious peritoneal/mesenteric findings.
Lymph Nodes: No suspicious hypermetabolic or pathologically enlarged lymph nodes in the abdomen or pelvis.
Pelvic Viscera: No suspicious findings.
Vasculature: Normal caliber of the abdominal aorta.
Free Fluid: No ascites or drainable fluid collection.


Skeleton and Soft Tissues:
No suspicious hypermetabolic osseous or soft tissue lesions.
No aggressive osseous lesions.
Moderate FDG activity fusing to the right chest wall soft tissue and intercostal space is likely secondary to recent thoracotomy, maximum SUV 4.0.

Impression:
1. Metabolically active nodal disease above diaphragm, predominantly a large intensely hypermetabolic centrally necrotic anterior mediastinal mass with invasion/involvement of multiple mediastinal structures and compression of the right upper and right middle lobe bronchi and associated atelectasis.
2. No metabolically active nodal disease below diaphragm.
3. No metabolically active extra-nodal disease.