Lung Cancer - Patient with a history of non-small cell lung cancer

March 2004 History
73-year-old male with a 1.3 centimeter left upper lobe lung mass with mediastinal adenopathy. Patient is status post right nephrectomy.

March 2004 PET/CT Findings
The left upper lobe 1.3 centimeter lung mass is moderately hypermetabolic with SUV value of 4.3. This is considered malignant by PET criteria. There are 2 to 3 pre-vascular lymph nodes, which show increased fluorodeoxyglucose uptake. The larger pre-vascular lymph node does not show increased fluorodeoxyglucose uptake. There is no suggestion of left hilar adenopathy.

Neck, abdomen and pelvis show physiologic fluorodeoxyglucose metabolism. The right kidney is present and is atrophic. There are a few left renal cysts. Osseous uptake is unremarkable.

March 2004 Impression
1.3 centimeter left upper lobe lung malignancy with the local metastatic disease to the pre-vascular space. No other fluorodeoxyglucose metabolism suspicious for metastatic disease. No disease below the diaphragm.

March 2004 Dosage
10.3 mCi FDG

May 2005 History
74-year-old male with a history of non-small cell lung cancer. The patient underwent external beam radiation therapy with chemotherapy in 2004. CT of the chest demonstrated left upper lobe infiltrate with bronchiectatic changes and smaller nodular density in the lingular segment. PET/CT to rule out tumor recurrence.

May 2005 PET/CT compared with March 2004 PET/CT.

May 2005 PET/CT Findings
The patient has a large left pleural effusion as well as significant lung infiltrate and atelectasis mainly in the upper lobe. Surprisingly, there is only mild inflammatory uptake throughout the left lung. There is no focal hypermetabolic activity that is suggestive of residual malignancy. The lingular segment density seen on the October 2004 CT of the chest is stable and does not show significant fluorodeoxyglucose uptake to suggest malignancy. Right lung appears clear. There is no metastatic disease in the neck, abdomen or the pelvis.

May 2005 Impression
The patient has significant infiltrative process in the left upper lobe, to a lesser extent left lower lobe with large left pleural effusion. There is no focal hypermetabolic activity as seen on the March 2004 PET/CT exam to suggest residual malignancy.

May 2005 Dosage
11.2 mCi FDG

Courtesy of
Thompson Cancer Center