Wk 3, Case 2 - 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:
---year-old male with history of thyroid cancer. Status post two stage thyroidectomy (2014 and 2020), I-131 ablation. Then patient was found to have manubrial, lung and left cervical nodes metastasis, status post resection of manubrium, left neck dissection; Wedge resection of right middle lobe metastasis in 2021. Patient is currently on sorafenib. PET/CT performed for restaging.

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

Comparison/Correlation:
--

Findings:
Technical quality: Diagnostic.
Measurements: Unless otherwise specified, all SUVs refer to maximum value in the target and all CT linear measurements are performed on axial images.

Reference: mean SUV liver: ----

Head and Neck:
Intensely hypermetabolic right level IVA lymph node along the right-sided thyroidectomy bed with maximum SUV of 6.4.
Intense focal FDG activity fusing to a small 7 x 5 mm subcutaneous nodule at the right anterior lower neck adjacent to a surgical clip, likely related to prior thyroidectomy surgery, maximum activity of 5.5.
Near complete opacification of the right maxillary sinus. Focal activity fusing to the right maxillary first molar tooth root, maximum SUV 5.4, likely odontogenic disease.
Surgical changes of total thyroidectomy.


Chest:
Intensely hypermetabolic 9 x 8 mm right lower lobe nodule with maximum SUV of 7.9.
Few bilateral non-FDG avid noncalcified small sub-centimeter nodules that are below the PET resolution.
No suspicious hypermetabolic mediastinal, hilar, or axillary adenopathy.
Post-surgical changes from right middle lobe wedge resection.
Stable cardiomegaly.
Stable dilated main pulmonary artery.
Multivessel coronary artery calcifications.


Abdomen and Pelvis:
No suspicious hypermetabolic activity in the abdomen or pelvis.
Solid Abdominal Organs:
No suspicious focal hypermetabolic activity in the liver significantly
greater than the heterogeneous physiologic uptake.
Moderate to severe hepatic steatosis.
Normal gallbladder.
Large bilateral non-obstructing renal calculi with perinephric stranding.
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 pathologically enlarged or hypermetabolic lymph nodes in
the abdomen or pelvis.
Pelvic Viscera: Multiple bladder calculi.
Vasculature: Normal caliber of the abdominal aorta.
Free Fluid: No ascites or drainable fluid collection.


Skeleton and Soft Tissues:
No suspicious hypermetabolic activity in the visualized osseous structures.
Non-FDG avid lucency in the proximal right humerus, likely benign.
Surgical changes from sternal manubrial osteotomy. No suspicious focal FDG uptake at surgical bed.
Degenerative changes throughout the spine.

Impression:
1. Intense focal FDG activity fusing to a small subcutaneous nodule at the right anterior lower neck adjacent to a surgical clip, likely related to prior thyroidectomy surgery, concerning for recurrence.
2. Intensely hypermetabolic right level IVA cervical lymph node, suspicious for metastatic disease.
3. Intensely hypermetabolic metastatic right lower lobe solid nodule.