Lung Cancer Case 02


Clinical History
67-year-old man with 3 pulmonary nodules detected on a recent CT scan, was referred for a PET/CT scan.

Imaging Findings
NUCLEAR MEDICINE PET/CT
STATED REASON FOR REQUEST: Staging lung cancer
TECHNIQUE: Emission scanning was performed extending from the base of the skull through the pelvis approximately 1 hour post radiotracer injection. Images were reconstructed with and without attenuation correction using the CT attenuation coefficients.
BLOOD GLUCOSE: 97 mg/dL
COMPARISON: Previous outside CT scan.

PET/CT FINDINGS: There were 3 nodules noted on the CT portion of this examination, 2 in the right lung and 1 in the left. The medial lesion within the right lung demonstrated marked radiopharmaceutical uptake. The remaining nodule in the right lung and the left lung nodule demonstrated no significant radiopharmaceutical uptake.

Differential Diagnosis
The differential for this finding would include a second primary malignancy which is not glucose avid such as bronchoalveolar carcinoma or a well differentiated adenocarcinoma or a benign lesion such as hamartoma or granuloma.

Discussion
This is a very interesting case of a gentleman with 3 pulmonary nodules on an outside CT scan. He was referred for a PET/CT scan, which showed only 1 of the 3 nodules was glucose avid. A subsequent biopsy of the glucose avid nodule showed adenocarcinoma. The surgeon and the patient decided to resect all 3 nodules. The pathology of the 3 nodules showed adenocarcinoma, a more peripheral area of infarct from tumor embolus and in the other lung a benign hamartoma. In this particular case, PET/CT accurately identified the malignant nodule from the other 2 benign nodules.

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.