Patient: El-Said, Mohammad, Khalefa EL-HOSSINY

ID: FL1076375

DOB: 12/1/1959

Age/Gender: 57Y, M

Procedure: PET CT

Study Date: 9/16/2017 11:26:14 AM

Order #: FL1107000

Report Status: Finalized

Whole Body F18- FDG PET/CTstudy

Clinical history:-

59 year- old male patient, Known case of Hodgkin lymphoma

Type of the study: initial study.

Procedure:

Radiopharmaceutical: 18F FDG, 5 mCi I.V.

Blood glucose level at time of 18F-FDG injection: 82 mg/dL .

Time from 18F-FDG injection to scan: 60 min

Technique :MDCT diagnostic post contrast examination was taken after I.V. non-ionic contrast
administration for attenuation correction anatomic localization followed by PET images from the skull
vault to the mid thigh were obtained.

Images of CT and corresponding functional PET images are taken in axial, coronal and sagittal planes.

Patient's height: 170 cm patient's weight: 60 kg

SUV average of reference hepatic activity = 2.29

PET/CT FINDINGS:-

Head and Neck:

Multiple metabolically active FDG avid lymph nodes are seen involving:
Bilateral submandibular LN group.

Bilateral cervical group II,III,IV and V appears amalgamated with SUV max 9.87 and SUV peak 8.83 at Rt
group V .

Bilateral supraclavicular lymphnodes with SUV MAX =5.73 AND SUV peak =4.68

Bilateral internal mammary lymph nodes with left internal mammary LN measuring 16x15mm with SUV
max 6.18 and SUPeak=3.28

The brain exhibited normal FDG bio-distribution

Physiologic FDG uptake is seen in the oropharynx, salivary glands, and larynx.

No focal or diffuse thyroid gland FDG uptake could be elicited.

Chest:

Extensive bilateral amalgamated FDG avid axillary lymph nodes are noted the most metabolically active
is seen at the left axillary group measuring 8 x 7 cm with SUV Max =7.17 , SU peak 6.56 with metabolic
volume = 211cc.

Multiple FDG avid mediastinal lymph-nodes are seen (prevascular, pretracheal , aorto-pulmonary and
subcarinal) the hottest is at the retrosternal prevascular region with SUV max = 5 peak = 4.47.

An intermuscular nodule is noted posterior chest wall at the level of left kidney measuring 2.4 x1.4 cm
with SUV max = 7.4 and SUV PEAK= 6.

Normal FDG uptake is seen throughout both lungs with no FDG avid lung nodules or masses detected.

There are no pleural or pericardial abnormalities.

Physiologic FDG uptake is noted in the myocardium.

Abdomen and Pelvis:

The spleen is enlarged in size 20 cm showing mild diffuse FDG uptake with SUV max= 5 most likely
attributed to hyperactive marrow due to any sort of cytopenia.

Multiple bilateral metabolically active FDG avid lymph nodes are seen showing heterogenous FDG
uptake at the following sites:

Splenic hilum ,perigastric, celiac, porta-hepatis ,peripancreatic ,superior mesenteric, retrocaval, para-
aortic ,inferior mesenteric and mesenteric lymph nodes are seen, the hottest is seen at splenic hilum
with SUV max 10.3 and peak 8.6 with metabolic volume measuring 44 cc measuring 3.6 cm in its longest
axis.

Multiple low metabolic activity retrocrural lymph nodes are noted .

Bilateral FDG avid common iliac ,external and internal iliac lymph nodes as well as bilateral inguinal LNs
are noted more pronounced at the left side the hottest is seen at the Lt inguinal region with SUV max
=9.4 and peak= 6.87 the largest left inguinal LN measures 2.8x2.5cm .

No evidence of lymphomatous infiltration of the liver, kidneys and pancreas.

There are no FDG avid adrenal nodules.

Physiologic FDG excretion is seen in the kidneys and bladder.

No evidence of ascites

Musculoskeletal:

Bilateral symmetrical low metabolic FDG uptake is seen involving both femoral shafts and metaphysic
likely attributed to hyperactive marrow, yet no evidence of focal increased FDG uptake to account for
lymphomatous infiltration.

Conclusion:

A known case of Hodgkin lymphoma, initial PET/CT revealed positive study for multiple metabolically
active FDG avid supra and infra-diaphragmatic nodal lesions as described (stage IV) .

Mild diffuse FDG avid splenic uptake likely attributed to marrow hyperstimulation ( due to any sort of
cytopenia), however early splenic infiltration couldn't be totally ruled out for follow up.

Much Obliged,

Dr Mennatallah Hatem SHALABY, MD

Prof Dr Shahira Ahmad

Prof DR Dalia Zidan

Prof Dr Hala Abo Senna