Lung Cancer Case 01


Clinical History
49-year-old man with suspected lung cancer presented for PET/CT evaluation. He underwent a chest X-ray that demonstrated a mass in the left lower lung field. He underwent a CT scan that demonstrated an 8 cm x 5 cm mass involving predominantly the left lower lobe. There were some infiltrative abnormalities in the left upper lobe as well. There was also questionable enlargement of the preaortic and AP window lymph nodes.

Imaging Findings
NUCLEAR MEDICINE PET/CT
STATED REASON FOR REQUEST: Staging lung cancer
TECHNIQUE: The patient was injected with radiopharmaceutical at rest. Approximately one hour later, coincident imaging was performed and reconstructed using CT attenuation correction. IV contrast was given for the diagnostic CT portion of the examination.
BLOOD GLUCOSE: 98 mg/dL
COMPARISON: Prior CT scan

CT FINDINGS: The CT scan demonstrated an 8 cm x 5 cm mass involving predominantly the left lower lobe. There were some infiltrative abnormalities in the left upper lobe as well. There was also questionable enlargement of the preaortic and AP window lymph nodes.

PET/CT FINDINGS: There was significantly increased radiopharmaceutical uptake in the large left lower lobe mass compatible with a known malignancy. In addition there were multiple foci of mild to significantly increased uptake in the mediastinum, including in the contralateral right paratracheal region, corresponding to lymph nodes and compatible with mediastinal involvement.

Discussion
This case demonstrates the utility of PET/CT in identifying mediastinal lymph node involvement. This patient was initially referred with a primary lung carcinoma and questionable mediastinal lymph node involvement. The PET/CT scan accurately identified small contralateral mediastinal lymph node metastases making the patient a stage III-B, normally considered to be non-operable.

Data courtesy of Dr. Todd Blodgett, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

* Any of the protocols presented herein are for informational purposes and are not meant to substitute for clinician judgment in how best to use any medical devices. It is the clinician that makes all diagnostic determinations based upon education, learning and experience.