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PELVIS ABSCESS DUE TO ANAL PERFORATION
Authored By: Joanna Fair and Akash Sharma.
Patient: 74 year old
History: 74 year old patient: Recurrent squamous cell carcinoma of the right pharynx, on chemotherapy.  Monitoring treatment response.
Image Size:[small][as-submitted]

Multimedia: 174057_1_submitted.avi
Current FDG-PET.

Multimedia: 174057_2_submitted.avi
FDG-PET three months previously.

Fig. 3
Axial PET-CT images of the neck show a metastatic lymph node in the left neck.

Fig. 4
Axial PET-CT show focal activity in recurrent tumor in the right supraglottic larynx.

Fig. 5
Axial PET-CT images show FDG-avid soft tissue, fluid and air in the right pelvis.

Fig. 6
Additional axial PET-CT images show that this soft tissue abuts a thickened rectal wall.
Image Size:[small][as-submitted]

Findings: Radiopharmaceutical:  14 mCi F-18 Fluorodeoxyglucose i.v.

The current rotating MIP images (Fig. 1) demonstrate two areas of focal uptake in the neck, improved since the prior examination (Fig. 2).  However, there is a new area of abnormal FDG activity in the right pelvis (Fig. 1).

Axial PET-CT images confirm a metastatic lymph node in the left neck (Fig. 3), as well as uptake in the primary tumor in the right supraglottic larynx (Fig. 4).  Additionally, the focal uptake in the pelvis corresponds to gas-containing inflammatory soft tissue and fluid in the right pelvis and presacral space (Fig. 5), abutting a thickened rectal wall (Fig. 6).
Diagnosis: Right pelvic and presacral abscess, presumably due to a perforated anus or rectum.
General Discussion: Full patient history:

74-year-old male with recurrent squamous cell carcinoma of the right pharynx. He was originally diagnosed 14 years ago and underwent primary resection with radiation therapy. A second resection was performed in four years ago after recurrence; no additional treatments were instituted at that time. One month prior to the earliest PET-CT, the patient noticed a new lesion in his mouth with swollen lymph nodes. The patient subsequently underwent surgical biopsy that showed recurrence disease, and he was placed on chemotherapy.

At the time of the followup PET-CT, the patient had not specifically reported any symptoms suggestive of a pelvis abscess.  The pelvic abscess and concern for rectal perforation were reported to the referring clinician. 

One week after the PET-CT, the patient developed anal pain and significant purulent drainage. He was seen in a surgeon's office, where he was found to have a draining abscess, which appeared to be intersphincteric and tracking proximally from the dentate line. He was brought to the operating room for an exam under anesthesia and drainage of this abscess cavity.
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Additional Details:

Case Number: 174057Owner(s): Joanna Fair and Akash SharmaLast Updated: 12-07-2011
Anatomy: Other   Pathology: Other
Modality: PETAccess Level: Readable by all users, writable by NucMed Certifiers
Keywords: ptnm, abscessACR: 70000.21000, 20000.37300

Case has been viewed 22 times.
Certified by Akash Sharma on 10-29-2010

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