Case Author(s): Sarah Reimer, MD , Keith Fischer MD, and Farrokh Dehdashti, MD , 03/19/99 . Rating: #D3, #Q4

Diagnosis: Non-Hodgkin's Lymphoma

Brief history:

S/p bone marrow transplant for NHL, now with fever and malaise.

Images:

Anterior and posterior whole body gallium images obtained at 72 hours

View main image(ga) in a separate image viewer

View second image(pt). Projection image from FDG PET scan

View third image(pt). Coronal image from FDG PET scan

Full history/Diagnosis is available below

Diagnosis: Non-Hodgkin's Lymphoma

Full history:

This is a patient with a high-grade NHL, s/p bone marrow transplantation 4 months previously. He presented with a palpable spleen, pancytopenia, dyspnea, and fever. The patient had had an MRI with gadolinium one week prior to the Gallium scan. The MRI showed findings most consistent with multiple peripheral splenic infarcts, increasing splenomegaly, and no change in multiple small retroperitoneal lymph nodes.

Radiopharmaceutical:

Gallium-67 citrate i.v. F-18 fluorodeoxyglucose (FDG) i.v.

Findings:

The Gallium scan demonstrated splenomegaly without focal increased activity to suggest tumor and no evidence of residual nodal disease.

The FDG-PET scan demonstrated splenomegaly with intensely increased activity. Multiple right axillary, mediastinal, mesenteric, celiac, and retroperitoneal lymph nodes were also intensely FDG-avid. The liver had heterogeneous uptake and there was diffusely increased activity in the bone marrow.

Major teaching point(s):

FDG-PET can be used to more reliably detect recurrent/residual lymphoma.

ACR Codes and Keywords:

References and General Discussion of Gallium Scintigraphy (Anatomic field:Vascular and Lymphatic Systems, Category:Misc)

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Case number: ga006

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