MyPACS.net: Radiology Teaching Files > Case 1807588

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Contributed by: Nuclear Medicine, Radiologist, Stanford University, California, USA.
Patient: 41 year old male
History:

The patient is a 41-year-old male with a history of
gastrointestinal stromal sarcoma, low grade, arising from the
ileum/cecum, status post right hemicolectomy, 04/1998.

This case has no images yet.
Findings:

FINDINGS:

BRAIN: Negative for hypermetabolic disease on this limited
evaluation.

HEAD AND NECK: Physiologic activity is appreciated. There is no
evidence of cervical hypermetabolic lymphadenopathy. There is a
hypermetabolic left supraclavicular, level IV subcentimeter lymph
node, transaxial slice 39, SUV 3.5. There are two hypermetabolic
subcentimeter right supraclavicular level IV lymph nodes:
representative transaxial slice 42 with SUV 3.8, and slice 45
with SUV 3.8.

CHEST: There are multiple hypermetabolic mediastinal lymph nodes
including: representative transaxial slice 56 with SUV 7, right
paratracheal; representative transaxial 58 with SUV 7.1, left
paratracheal; slice 60, SUV 7.2, prevascular; slice 63, SUV
10.7, AP window; slice 63, SUV: 7, precarinal.

There is bilateral hypermetabolic hilar lymphadenopathy:
representative transaxial slice 66 with SUV 8.2 on the right and
slice 67 with SUV 5.6 on the left.

There is a small focus of mildly increased FDG uptake involving the
soft tissue just to the right of the sternum at about the level of T6,
transaxial slice 67, SUV 2.7. This appears to localize to a
subcentimter right internal mammary lymph node.


There is a discrete, rounded focus of increased FDG
uptake located just posterior to the sternum at about the level of
T9, representative transaxial slice 84, SUV: 5.8. There is no
definite CT correlate. This would be compatible with a cardiophrenic
lymph node. There is focal increased FDG uptake involving right
cardiophrenic lymph node, representative transaxial slice 91, SUV 3.5.
There is focal increased FDG uptake involving the right scapula,
representative transaxial slice 63, SUV 4.5.

The bilateral lungs are negative for abnormally increased FDG
uptake. Physiologic cardiac activity is present. There is no
evidence of axillary hypermetabolic lymphadenopathy.

ABDOMEN/PELVIS: There is focal increased FDG uptake involving a
gastrohepatic lymph node, transaxial slice 94, SUV
4.5. There is a relatively large focus of irregularly shaped FDG
uptake involving the portacaval and porta hepatis regions,
transaxial slices 101-113, SUV 12.6.

There is a focal right mesenteric hypermetabolic
lymphadenopathy, representative transaxial slice 132, SUV: 9.

There are two relatively small foci of increased FDG
uptake involving the left iliac bone, representative transaxial
slice 154, SUV 3.5. There is a small focus of borderline
increased FDG uptake involving the right iliac bone, transaxial
slice 154, SUV 2.2.

There are 2 right iliac hypermetabolic soft tissue foci,
representative transaxial slice 162 with SUV 3.5 and slice 164 with
SUV 3.5. There is a small focus of borderline increased FDG uptake
involving the left proximal femoral shaft, transaxial slice 184, SUV
2.

Examination of the spleen, gastrointestinal tract and urinary
system shows physiologic activity. This scan is negative for
inguinal hypermetabolic lymphadenopathy.

Diagnosis:

IMPRESSION:

1. HYPERMETABOLIC BILATERAL SUPRACLAVICULAR, MEDIASTINAL,
BILATERAL HILAR, RIGHT INTERNAL MAMMARY, RIGHT CARDIOPHRENIC AND RIGHT
PROBABLE EXTERNAL ILIAC LYMPHADENOPATHY IS SUSPICIOUS FOR MALIGNANCY.

2. HYPERMETABOLIC PORTACAVAL, PORTA HEPATIS AND GASTROHEPATIC
LIGAMENT LYMPHADENOPATHY IS SUSPICIOUS FOR MALIGNANCY.

3. FOCAL RIGHT SCAPULA AND LEFT ILIAC SKELETAL HYPERMETABOLISM IS
SUSPICIOUS FOR MALIGNANCY.

4. FOCAL BORDERLINE RIGHT ILIAC BONE AND LEFT PROXIMAL FEMUR
HYPERMETABOLISM IS OF UNCERTAIN ETIOLOGY.

Comments:
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Additional Details:

Case Number: 1807588Last Updated: 06-30-2005
Anatomy: Gastrointestinal (GI)   Pathology: Neoplasm
Modality: CT, PETExam Date: Access Level: Readable by all users
Keywords: supraclavicular, mediatinum, iliac, portacaval, porta hepatis, scapula

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