A 25 years old male, an architect by profession, came to us in March 2019, with complaints of persistent sensation of constriction in the whole chest since 4 to 5 months. It was progressively increasing. Since a week he had a dry cough < warm room, cold air and difficulty in inspiration.
Chilly, Appetite/ Thirst/ Urine/Stool/Sleep normal and unaltered.
He was detected to be positive for HIV 3 years ago and was on anti-retroviral drugs. Since 1 year he was not sexually active.
X Ray followed by biopsy confirmed B-Cell Lymphoma.
Started him on Bromium 0/1 in ascending potencies every week and continued anti-retroviral therapy. Bromium in this case is a symptomatic prescription based on persistent constriction in the whole chest, dry cough, < warm room, cold air and difficulty in inspiration. Chilly.
The X-Ray done on 17/8/2019 shows marked regression of the tumour plus he has been asymptomatic since 1 month.
PECT SCAN (18/8/2019)
IMPRESSION: Marked improvement of previously seen large hypermetabolic lymph nodes with the exception of a residual small anterior mediastinal hypermetabolic lymph node, as above. Deauville 4. Deauville five-point scale (Deauville 5ps) is an internationally recommended scale for clinical routine and clinical trials using FDG-PET/CT in the initial staging and assessment of treatment response in: Hodgkin lymphoma (HL), any type, Diffuse large B cellular lymphoma (DLBCL), Marginal zone NHL with aggressive transformation
FDG-avid nodal lymphomas, essentially all histologic types except: chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma, lymphoplasmocytic lymphoma, Waldenstrom macroglobulinaemia, mycosis fungoides
Each FDG-avid (or previously FDG-avid) lesion is rated independently:
- No uptake above background.
- Uptake < mediastinal blood pool.
- Uptake > mediastinum but < liver.
- Uptake moderately increased compared to the liver.
- Uptake markedly increased compared to the liver or uptake at a new site.
PET/CT IMAGING STUDY WITH LOW-DOSE ATTENUATION CORRECTION CT OF THE
CHEST, ABDOMEN AND PELVIS
INDICATION: Large B-cell lymphoma lymphoma. The study is requested for restaging.
RADIOPHARMACEUTICAL: 11.6 mCi of F-18 FDG injected intravenously.
PROCEDURE: One hour following injection of the radiopharmaceutical,
PET imaging was performed from the base of the skull to mid-thighs. A low dose non-contrast CT scan of the same region was also performed solely for the purpose of attenuation correction and anatomic co-registration with PET images. Oral contrast was given per protocol.
Base of Skull and Neck
Previously seen conglomerate of large left cervical lymph nodes are no longer appreciated.
Partially visualized brain cannot be completely assessed on this study.
Normal distribution of the radiotracer in nasopharyngeal, oropharyngeal, and laryngeal structures.
Normal distribution of the radiotracer in the mucosal surfaces, salivary glands and thyroid gland.
Right chest wall port with catheter tip in the right atrium, new.
Marked resolution of hypermetabolic conglomerate of lymph nodes in the mediastinum except for a small anterior mediastinal lymph node measuring up to 2.3 cm with SUV max 5.9 (previously SUV max 33.3).
Mediastinal blood pool SUV max 2.0
Normal distribution of the radiotracer in the bilateral lung parenchyma.
Abdomen and Pelvis
Liver SUV max 3.5
Normal-sized spleen with diffuse increased uptake likely physiologic related to extra medullary erythropoiesis.
Normal distribution of the radiotracer in the liver, pancreas, GI tract, adrenal glands, and kidneys.
No hypermetabolic mesenteric, pelvic, retroperitoneal or inguinal lymphadenopathy.
Intense diffuse uptake throughout the bone marrow likely related to
bone marrow hyperplasia.