Memorial Hospital, Springfield, IL

History

31 year old female with breast cancer

Image Findings

Bone scan

The entire skeleton was imaged in anterior and posterior projections by the body sweep technique. In addition, spot lateral views of the skull and cervical spine were obtained and oblique views of the rib cages were also performed.

There is a faint area of slight increased bone tracer accumulation demonstrated along the lateral portion of the right 9 th rib. No other evidence of abnormal increased bone tracer accumulation demonstrated within the imaged skeleton. Statistically, even in patients with known malignancy, solitary abnormality in the rib cage is more likely to be related to previous trauma. It is recommended that this area be correlated with high detail radiographs of this portion of the rib cage for further evaluation. Nothing else remarkable noted.

PET scan

Dedicated whole body ring pet was obtained from the level of the neck to the upper thighs. Correlation is made with the recent bone scan obtained here as well as outside CT of the chest, abdomen and pelvis, MR of the left hip and plain films of the pelvis obtained at the Springfield Clinic.

The PET scan shows three foci of very intense activity in the right axilla consistent with uptake in axillary lymph nodes. There is a fourth, less intense area of increased uptake in the mid axilla are showing SUVs of 4.5 and 6.6. This degree of activity is usually related to neoplasia. However, the patient has had a recent mastectomy and it is therefore possible that the activity could be reactive.

There are no other foci seen elsewhere in the body to indicate malignancy. Specifically, no evidence of abnormal uptake in the right lower rib cage laterally where the bone scan was positive. There is also no evidence of abnormal uptake around the left hip where there was a positive plain film and MRI.

There is some increased activity, mild in degree in the supraclavicular regions bilaterally but this is felt to be due to activity in the muscles which is felt to be physiologically.

Dose

Bone scan – 26 millicuries Tc-99mHDP IV – left antecubital fossa
PET scan – 12.13 millicuries of F18-FDG; Injection site – IV LAF