Patient Name:- Mohamed Taher El shobaky Date :- 14/7/2021

Referring physician: ID:

Whole body FDG PET CT Study

Clinical Data:-p
o 77 year old male patient has old treated gastric carcinoma . recently
developed Rt. lower lung lobe lesion for PET-CT evaluation.
Technique:-
• Approximately one hour after IV administration of around 11 mCi of f-18 FDG,
whole body PET was acquired from the skull level till the mid-thighs. Both arms
were placed in extension position above the heads. CT was also done aiming at
anatomic localization and; attenuation correction and obtaining fusion images. IV
contrast was given; about 80-100 ml. data was processed and displayed into the
usual cuts. FBS at tracer injection time was normal [104 mg/dl].
PET/CT Findings: -
I. Loco-regional:
• Gastric: -
▪ Post partial proximal gastrectomy with reconstruction
anastmosis showing no evidence of active local tumoral
mural thickening or recurrent mass lesions.
▪ PO sequel :- Partial gastrectomy, reduced gastric
compliance, proximal oesophogeal dilatation with
fibrotic changes at celiac region and surgical clips.

• Regional Nodes :-
▪ No active regional nodal lesions detected. Few tiny
reactive inflammatory nodes are seen at celiac and
epigastric area.
II. Distant:-
• No active distant deposits detected.
• Incidental finding :-
o Pulmonary :- Fairly defined non-enhanced pleural
based wedge shaped segmental consolidative Rt. lower
lung lobe lesion with hetrogenous yet low attenuation
density This lesion is seen centered at apical segment
of Lower Rt. lung lobe with early appearance of air
bronchogram, minimal marginal speculation and . This
lesion globally measured 2.8 x 2.3 cm with low grade
activity SUV max = 2.7.
o Associated tiny Rt. upper lung lobe nodule likely
inflammatory for FU.

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 o Mediastinal node :-
o Tiny reactive Rt. hilar node with non-significant
metabolic activity (SUV max 1.8). calcified Rt. para-
tracheal node. Otherwise no active pathological nodal
lesion detected.
II. Diagnostic CT Findings:-
• Spleen :- Average size with small cyst.
• Anterior abdominal wall scare with multiple clios and healing granulation
tissue and hernioraphy.
• Age related muscle-skeletal changes implicating osteoporosis & internally
fixed fracture of Lt. femur as well as with generalized myopathy.
• Generalized atherosclerosis.
• No pericardial, pleural or peritoneal collection.
• Liver , Adrenals, & IVC are unremarkable.
OPINION

** FU PET-CT for patient with old treated gastric carcinoma and

recent developed Rt. lung lesion shows :-
o Loco-regional :-
o Gastric :-
▪ Evidence of partial proximal gastrectomy with
reconstruction and long term PO sequel.
▪ Operative bed :- clear operative bed with no active
recurrent tumoral mass lesions detected.
o Regional nodes :-
▪ No active regional nodal deposits detected.
o Distant :-
o No definite active distant deposits detected.
Incidental finding :-
Pulmonary :- Fairly defined non-enhanced pleural based wedge
shaped segmental Rt. lower lung lobe consolidative lesion with
heterogeneous yet low attenuation density and low grade activity. The
current pattern (activity and low density) with early appearance of
cavitation may raise a possibility of infectious rather than neoplasia
for close FU. Short term FU CT chest after specific TTT may be of great
help in such case.
Post. Operative and Age related muscle-skeletal changes with
generalized myopathy..
Nuclear Medicine Unit

Dr. Zainab Singer, MSc Prof. Magdy Kotb, MD

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