PET/CT scan results, 13 July 2023

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Comments from the Doctor's Office

I have reviewed the results of your PET CT scan. There is evidence of spread to the liver, bone, right adrenal gland, in addition to the known involvement of the lung which is more extensive than appreciated on your prior CT. The extent of disease at this point would prohibit the utilization of surgery. Primary treatment would be some type of systemic therapy.

Please send me a MyChart message if you have any additional questions.
Thank you for choosing MUSC!
Jennifer Lynn Harper, MD

Study Result

Impression

IMPRESSION:
Intensely active left apical lung carcinoma with extensive bilateral
hilar/mediastinal adenopathy, lymphangitic carcinomatosis throughout
both lungs, intensely active osseous metastasis throughout the axial
and appendicular skeleton not present 2 years ago on CT PET scan as
well as numerous intensely active hepatic metastasis and right
adrenal metastatic lesion.

SIGNATURE:

Electronically Signed
By: Noel Phipps M.D.
On: 07/13/2023 16:57



Narrative

EXAM:
NUCLEAR MEDICINE SKULL BASE TO THIGH PET/CT

CLINICAL DATA:
Newly dx lung cancer w/ mediastinal nodes, initial staging for this
58-year-old male patient previously treated initially treated 2016
with XRT for laryngeal squamous cell carcinoma and ultimately
salvage laryngectomy.

COMPARISON:
10/20/2021 CT PET scan

TECHNIQUE:
Following the intravenous administration of F-18 FDG, dedicated
PET/CT performed with field of view from the skull base to the
midthigh. CT performed for attenuation correction and localization
purposes only.

CT scans at this facility use dose modulation, iterative
reconstruction, and/or weight based dosing when appropriate to
reduce radiation dose to as low as reasonable achievable.

F-18 FDG dose: 13.5 mCi with imaging 65 minutes post injection.

Patient glucose level: 111

Background liver activity measures about 3.2 SUV with numerous
intensely active metastatic lesions throughout the liver above
background. Mediastinal background activity measures 2.2 SUV.

FINDINGS:
Intensely active 2.4 cm diameter spiculated left apical lung nodule
is seen 17.7 SUV characteristic of recently biopsy-proven non-small
cell lung carcinoma with extensive pre-vascular, bilateral hilar,
subcarinal and right paratracheal metastatic adenopathy.
Reticulonodular interstitial densities are seen throughout both
lungs characteristic of lymphangitic carcinomatosis.

Intensely active deep left parotid node 12.4 SUV is seen as well as
another similarly active lesion (7.8 SUV) in the left temporalis
muscle, intensely active clivus bone lesion (4.2 SUV) right of
midline. Numerous intensely active osseous metastasis throughout the
axial and appendicular skeleton not present 2 years ago on CT PET
scan. Normal thoracolumbar alignment is maintained without evident
pathologic fracture.

8 x 15 mm right adrenal nodule 10.9 SUV. Left adrenal gland is
normal.

Numerous intensely active hepatic metastasis are seen throughout the
liver as well as active as 17.0 SUV anteriorly caudal margin right
lobe of the liver.

Adrenal glands are normal. No radiographically evident obstructing
stone, renal mass, renal cyst, hydronephrosis, hydroureter or
duplication variant.

Postsurgical change from salvage laryngectomy with skin flap
placement without recurrent neck mass or cervical adenopathy having
had cervical lymph node dissection.


Result Notes

Notes recorded by JENNIFER LYNN HARPER on 7/13/2023 at 5:12 PM EDT
RESULTS REVIEW - I have reviewed these results and have called the patient. Patient was not available by phone so I left a detailed voicemail message regarding the results and how this would affect neck steps in his treatment.

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