Case Author(s): David A. Hillier, M.D., Ph.D. and Farroqh Dehdashti, M.D. , . Rating: #D2, #Q3
Diagnosis: Mesothelioma
Brief history:
61 year-old man with left pleural thickening.
Images:
PET study
View main image(pt) in a separate image viewer
View second image(pt).
PET coronal slices
View third image(xr).
Chest radiograph
Full history/Diagnosis is available below
Diagnosis: Mesothelioma
Full history:
61 year-old man with left mesothelioma. Evaluate extent of disease.
Radiopharmaceutical:
15 mCi fluorodeoxyglucose, IV
Findings:
1. FDG PET:
- Intense activity in pleura of left hemithorax. The extent
of disease was better defined by FDG-PET, when the PET results compared
with histopathological findings.
2. Follow up chest radiograph (3 weeks later):
- Status post pneumonectomy.
Discussion:
PET can be used to diagnose malignant mesothelioma and define
the extent of disease. Computed tomography cannot be used to
definitively distinguish malignant mesothelioma from benign diffuse
pleural thickening.
In a report by Bénard et al, FDG-PET was shown to be useful in differentiating
malignant mesothelioma (24/28) from benign pleural lesions (4/28). The
FDG uptake was significantly higher in malignant than benign lesions
(mean SUV = 4.9 ± 2.9 and 1.4 ± 0.6, respectively; p<0.0001). In
addition the extent of disease can be more reliably determined on
FDG-PET compared with CT. Lymph node involvement was noted on FDG-PET
in 12 patients, 9 of which appeared normal on CT.
References:
1. Baas P and Zoetmulder FAN. Malignant pleural mesothelioma.
Ann Oncol 1998; 9:139-149.
2. Bénard, François, et al. Metabolic imaging of malignant pleural
mesothelioma with fluorodeoxyglucose positron emission tomography.
Chest 1998; 114:713-722.
Followup:
The patient underwent pneumonectomy.
ACR Codes and Keywords:
References and General Discussion of PET Tumor Imaging Studies (Anatomic field:Lung, Mediastinum, and Pleura, Category:Neoplasm, Neoplastic-like condition)
Search for similar cases.
Edit this case
Add comments about this case
Return to the Teaching File home page.
Case number: pt026
Copyright by Wash U MO
