Presentation
Previous aortocaval and left para-aortic lymph node metastasis which was treated with radiotherapy. Now rising tumor markers.
Patient Data
focal activity located in the right pelvis, posterior to the curvilinear density
accumulated radiotracer in the dilated right renal pelvis and ureter
FDG avid foci identified in right iliac fossa (SUV max 8.9)
curvilinear activity overlying the liver capsule
patchy low-grade activity at the splenic hilum
patchy non-specific activity in the left upper lobe lingual segment with low-grade activity about the left supraclavicular lymph node
the FDG avid mass in the right pelvis correlates to the mass located at the posterior part of the surgical suture on the CT
the lesion is not separable from the surrounding bowel loops
right hydroureter and hydronephrosis
peritoneal soft tissue nodule in right iliac fossa
very faint curvilinear density overlying the liver, especially hepatic segments 7 and 8
subtle soft tissue density noted at the splenic hilum which correlates to the aforementioned FDG avid abnormality
patchy pulmonary infiltrates, likely inflammatory or infective in nature
Case Discussion
This case highlights the subtle peritoneal metastases on CT which can be easily missed. These lesions demonstrate FDG avidity on the PET scan which makes detection easier.
The dilated right renal pelvis and right ureter down to the level of the right pelvic lesion is most compatible with malignant obstruction/partial obstruction caused by the right pelvic lesion.
These newly found metastases are compatible with metastatic disease progression. This is in keeping with the patient's rising tumor marker.