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Lung adenocarcinoma and pet scanning a case study
1. Case Study
Prepared by Todd Charge
Section Manager
Nuclear Medicine & PET Centre
1
2. Background
SN, 49yr old male
Presented to GP with 4/52 history of
– SOBOE
– Rt sided chest pain on inspiration
– night sweats
– 10kg weight loss
– non-productive cough
– 10year history of smoking (22 yrs ago)
– 1 ½ packs/day
– previously well
3. Background
GP diagnosis of pleurisy on clinical examination
Treated with a single course of antibiotics
Re-presented to GP rooms one week later with
no resolution of symptoms
CXR requested by second GP
4. Imaging
CXR showed
– Rt Pleural Effusion
– Rt side mid zone lung mass measuring
6.5cmx4cm
– CT chest suggested
5. Imaging
Chest CT showed
– lobular soft tissue mass seen in the right mid
zone measuring about 78 x 62mm
– its lateral surface is in contact with the pleural
cavity
– consolidation could be seen in the right middle
lobe
– multiple oval soft tissue densities noted in
keeping with prominent mediastinal lymph
nodes. There is a large soft tissue mass lesion
seen in the right hilar region
10. Imaging
Large irregular uptake mass in Rt lung
Focus of abnormal uptake in Rt hilum
Two foci of low grade upgrade in Rt neck
Avid irregular uptake in almost entire Rt lung
pleura
14. Pathology
Pleural Effusion
– healthy individuals have less than 1 ml of fluid
in each pleural space
– fluid enters the pleural space from the
capillaries in the parietal pleura, from
interstitial spaces of the lung via the visceral
pleura, or from the peritoneal cavity through
small holes in the diaphragm
– fluid is normally removed by lymphatics in the
visceral pleura
16. Treatment
Talc Plureodesis
– seal the space between pleura with sterile talc
– incites an intense granulomatous pleural
inflammatory reaction
– irritate the pleura making it stick together
– stop fluid build up and relieve symptoms
– 5grams sterile talc
– can be done multiple times
– usually occurring within 24 hours, and often
persisting many months
18. Treatment
Chemotherapy
Radiation Therapy
SATURN trial - a phase III trial of erlotinib
(Tarceva) following chemotherapy as 1st line
treatment for non-small cell lung cancer
No effective therapy for pleural metastasis
Generally not curative
19. Complications
Empyema
– collection of inflammatory fluid and debris
within the pleural space
– resulting infection and inflammation can
proceed with adhesive bands form infected
fluid becomes loculated pus within the pleural
space
– high associated mortality rate related to
respiratory failure and systemic sepsis
20. Conclusion
Treatment not commenced due to empyema
PET can be invaluable in detecting pleural
involvement
Pleural metastasis signify unresectable disease
and carry great therapeutic and prognostic
implications
PET sensitivity 95%, specificity 67% for pleural
metastasis