Wk 1, Case 4 - 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 female with history of stage IB NSCLC status post VATS left lower lobectomy in 2020. Also, history of atypical ductal hyperplasia of the left breast status post left breast excisional biopsy in 2006 and history of CACG with plateau iris syndrome (anomalous large ciliary processes) Concern for recurrent lung cancer on imaging. PET/CT for restaging and subsequent treatment planning.

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: ----; previously: ----.

Head and Neck:
No suspicious hypermetabolic lesions within the head and neck.
Mild generalized brain parenchymal volume loss.
No obvious space-occupying brain parenchymal masses.
Bilateral lens prosthesis.
Unremarkable thyroid.
No suspicious cervical or supraclavicular adenopathy.


Chest:
Intensely hypermetabolic left supra-hilar soft tissue mass extending to the left subcarinal region with encasement and mild narrowing of the left mainstem bronchus, adjacent to the suture line from prior lobectomy, SUV max 13.3, most consistent with local recurrence with conglomerating regional adenopathy. This mass is challenging to measure on the non-contrast CT but approximately 2.6 x 4 cm in maximum axial dimension.
No other suspicious focal hypermetabolic uptake.
Bilateral apical pleural fibrosis.
No suspicious sizable pulmonary nodules within the aerated lungs to suggest satellite metastatic nodules.
Small to moderate layering left pleural effusion.
No right pleural effusion.
Normal caliber heart and mediastinal great vessels.
Trace pericardial fluid.


Abdomen and Pelvis:
No suspicious hypermetabolic lesions within the abdomen and pelvis.
No suspicious lesions within the solid organs on the non-contrast images.
Left hepatic cysts.
Colonic diverticulosis without signs of acute diverticulitis.
Grossly unremarkable female pelvic viscera and under distended urinary bladder.
No ascites.
Moderate non-aneurysmal aortoiliac calcific atherosclerosis.


Skeleton and Soft Tissues:
No suspicious hypermetabolic osseous or soft tissue lesions.
No aggressive lytic or blastic osseous lesions or aggressive body wall soft tissue masses.
Right iliac bone islands.

Impression:
1. Intensely hypermetabolic left supra-hilar soft tissue mass extending to the left subcarinal region with encasement and mild narrowing of the left mainstem bronchus, adjacent to the prior lobectomy suture line, most consistent with local recurrence with conglomerating regional adenopathy.
2. No additional sites of metabolically active metastatic disease.
3. Small-to-moderate left pleural effusion without abnormal focal hypermetabolic uptake.