Lung Cancer - 65-year-old with recent right lower lobe resection

History
65-year-old with recent right lower lobe resection referred for follow up PET/CT scan for postoperative medical management.

PET/CT Findings
There is abnormal increased FDG uptake in a focal area in the liver. In addition, there are multiple focal areas of abnormal increased FDG uptake, specifically corresponding to the right hilum and the L4 vertebral body.

Impression
Increased metabolic activity consistent with recurrent malignancy in the right hilar region, L4 vertebra and liver. None of the lesions are well visualized on the CT portion of the exam. However, these lesions are compatible with metastatic disease.

Discussion
This is an unfortunate case of a man who underwent right lower lobe resection for a primary squamous cell carcinoma. Six months later he was referred for PET/CT, which showed at least 4 metastatic lesions. Unfortunately, this patient did not have a preop PET/CT which likely would have shown at least one of the metastatic lesions and made the patient a non-operative candidate. Interestingly, all four metastatic lesions were not able to be seen on the CT portion of the scan. The liver lesion wasn’t well visualized on the CT portion of the exam either even with a good IV contrast enhanced exam.

Courtesy of
Dr. Todd Blodgett, University of Pittsburgh