Wk 1, 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 ----- with history of HIV. Most recent CT chest short interval increase in size of a right lower lobe pulmonary nodule. PET/CT is performed for metabolic characterization of this enlarging pulmonary nodule.

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 body weight only.
CT: Low-dose, non-breath-hold, without intravenous contrast.
TOTAL DLP (Dose Length Product): -- mGy cm.

Comparison/Correlation:
No relevant prior imaging for comparison

Findings:
Technical quality:--------.
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:
No suspicious hypermetabolic foci within the head and neck.
No suspicious hypermetabolic or pathologically enlarged cervical lymph nodes.
Mildly FDG avid sub-centimeter left intra-parotid nodule maximum SUV 2.5, likely primary parotid neoplasm such as pleomorphic adenoma or Warthin's tumor. Attention on follow-up scans recommended.
The thyroid is unremarkable.


CHEST:
The questionable pulmonary nodule within the right lower lobe azygo-esophageal recess exhibits mild to moderate FDG uptake, maximum SUV 3.5.
No suspicious hypermetabolic or pathologically enlarged mediastinal, hilar or axillary lymph nodes. Calcified mediastinal and right hilar lymph nodes.
Faint FDG avidity associated with a linear reticular slightly hyperdense opacity within the right upper lobe, maximum SUV 0.6, likely inflammatory.
Severe upper lobe predominant centrilobular emphysema.
Mild calcified atherosclerotic plaque of the thoracic aorta.
Multivessel coronary artery calcifications.


ABDOMEN AND PELVIS:
No suspicious hypermetabolic foci within the abdomen and pelvis.
There are no hypermetabolic or pathologically enlarged mesenteric, retroperitoneal, pelvic or inguinal lymph nodes.
Unremarkable liver, spleen, pancreas, adrenal glands, and kidneys.
Cholelithiasis.
Physiologic FDG avidity throughout loops of small and large bowels. Colonic diverticulosis.
There is no ascites.
Moderate aortoiliac atherosclerotic calcifications. Abdominal aortic aneurysm with chronic dissection.
Prostatomegaly, without associated focal hypermetabolism.


MUSCULOSKELETAL:
No suspicious hypermetabolic osseous or soft tissue lesions.
Mild FDG avidity associated with hypertrophic facets of the lower lumbar spine, maximum SUV 2.7, likely facet joint arthropathy.
Grade 1 anterolisthesis of C3 on C4. Multilevel degenerative changes.
Stable appearance of non-FDG avid mild superior endplate deformity of T12 with less than 50% loss of vertebral height.
There are no suspicious lytic or sclerotic osseous lesions.

Impression:
1. The questionable nodule within the right lower lobe azygo-esophageal recess exhibits moderate FDG uptake and highly suspicious for a primary lung malignancy. Tissue sampling recommended.
2. No convincing evidence of metabolically active regional or distant metastatic disease.