0:00

Okay, so moving right along let's go

0:03

on to case 10.

0:05

In this case is a little different because I have a pet as

0:08

you can see here and I'll show you the CT portion

0:11

first and then line up the pet.

0:17

And let me actually blow this up a bit.

0:22

All right. Okay. So this patient came in

0:25

for staging and has cancer and you

0:28

can see some enlarge lymph nodes here and you see

0:31

multiple stations involved some higher lymph nodes in here.

0:34

We had some subcrinal lymph nodes.

0:37

They're a little bit prominent. You see some low her

0:41

trachea lymph nodes in here as well. So let

0:44

me show you the head on that on this case and this

0:47

is from the same day.

0:53

And we see some of those lymph nodes. So we see some areas

0:56

of ftg uptake. There are very hot right

0:59

there.

1:00

And I see a lot of Ft yet ftg uptake, but

1:03

then I see something the correlates with about

1:06

this this level of the heart here. And

1:09

so the question is what is the most significant

1:12

abnormality that you see outside of the coronary calcification

1:15

that you see here? Where is the abnormality located

1:18

in this particular case? And you

1:21

may want to think just what is that abnormality? So

1:24

let me just show you the whole heart here.

1:27

And I'll scroll back.

1:34

Okay, so let's open the poll question and see

1:37

what people think about this abnormality.

1:39

So I'll leave this right in the middle here. What is

1:42

the location of the most obvious abnormality

1:45

or most significant abnormality here?

1:48

This slides the coronary disease.

1:59

Okay, so let's close the polling on this case and see

2:02

what people thought.

2:07

Okay, and we said septum so everyone said septum

2:10

and of course that's where the abnormality is.

2:13

So this is and Pitfall and

2:16

and you'll know what this Pitfall is.

2:19

It looks like so you have an area of high fdg uptake

2:22

right here. You can see it's as high as my cardio uptake

2:25

you can see that that corresponds to this area right

2:28

here where the septum is very thick and what I'm gonna do is blow

2:31

this up a bit September is very thick and

2:34

you might have noticed that there's a little bit of what looks like contrast coming

2:37

through the septum right there.

2:40

So the attenuation here, it looks

2:43

like fat largely, but it doesn't

2:46

look like clean fat. It. Looks like there's something within the

2:49

fat that fat looks a little bit dirty. The reason

2:52

for that is that this is so called like hummus

2:55

hypert hypertrophy of the interracial septum

2:58

and it's you know, really hypertrophy

3:01

of the fat here infiltration with fat and it's

3:04

brown fat and the brown fat is what is responsible

3:07

for being metabolically active and you

3:10

can see that's what causes the dirtiness the fat here. And that's why

3:13

it had a lot of uptake on the ftg pad.

3:16

You may have said yourself. Well, you know

3:19

is there and enter atrial septal

3:22

defect in ASD right here the the

3:25

reason that you're seeing what looks like contrast coming

3:28

through is not because there's actually a connection there's

3:31

no connection between the Atria here. In fact,

3:34

you can see something that looks like a thin something right here, but this

3:37

is the sparing the fossil of Alice.

3:40

That you get with this with this entity with

3:43

with what counters hypertrophy so it looks like in some

3:46

cases that there is an acid but

3:49

they're they're almost never is so lipomas hypertrophy

3:52

of the interracial septum. The other thing I would point out here is

3:55

that this is actually infiltrating or thickening

3:58

with fat a portion of the heart that you

4:01

should know the name of and this is the Christ the terminalis and it's

4:04

the ridge of tissue that lives along the posterior wall

4:07

of the right atrium. And this can become infiltrated in

4:10

this condition the fat can hypertrophy in this

4:13

can entity as well notice as

4:16

well that as you go along the SPC the SPC looks

4:19

like it's narrowed.

4:21

And it looks like this has Mass Effect upon it the fat

4:24

has mass effect from hypertrophy. But this almost

4:27

never has any functional consequence on venous

4:30

drainage in this

4:33

entity. So you'll see this and I've seen

4:36

cases that look even more dramatic than this but it almost

4:39

never has any functional consequence as far as you know

4:42

Venus obstruction. So so good so like

4:45

promise hypertrophy of the interagal septum. It can be a pitful

4:48

at head in particular and also can

4:51

be very echogenic at echocardiography.