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Lung adenocarcinoma and pet scanning   a case study

Lung adenocarcinoma and pet scanning a case study






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    Lung adenocarcinoma and pet scanning   a case study Lung adenocarcinoma and pet scanning a case study Presentation Transcript

    • Case Study Prepared by Todd Charge Section ManagerNuclear Medicine & PET Centre 1
    • 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
    • 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
    • Imaging CXR showed – Rt Pleural Effusion – Rt side mid zone lung mass measuring 6.5cmx4cm – CT chest suggested
    • 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
    • Morbidity & Mortality Lung Adenocarcinoma Stage IIIb: T(any), N3, M0 Stage 3b – 50% living at 12 months 5year survival 10%
    • Plan PET VAT Combined chemotherapy and radiation therapy
    • Imaging PET
    • Imaging PET
    • 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
    • Plan PET VAT Combined chemotherapy and radiation therapy
    • Treatment VAT (video-assisted thoracoscopy) Apical and basal drains inserted Tissue biopsies Adhesions Re-expanded Rt lung following collapse 1Lt blood stained fluid Pleural cavity “studded with mets” Talc Pleurodesis
    • Anatomy Pleura Space between the inner and outer lining of the lung
    • 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
    • Treatment Drainage 5.41Lt over 14 days
    • 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
    • Plan PET VAT Combined chemotherapy and radiation therapy
    • 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
    • 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
    • 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
    • Conclusion