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Here, we have a 60 year old female with a history of stage

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4 lung adenocarcinoma with history of

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plural metastases now representing for her follow up to

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her oncology appointment.

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The patient actually has been tolerating chemotherapy but reports

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increasing dyspnea and left upper quadrant

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pain.

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She's referred for CT scan of the chest after.

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Interval chemotherapy has been administered.

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So what do we see?

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Interestingly in the reading room the CT

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scan is unable to identify any discrete nodules.

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Marvelous interval improvement

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post chemotherapy no evidence of new

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or residual pulmonary disease. So for

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full rule out of the seminated disease. The patient

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is actually scheduled for further Imaging with a PET scan.

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So what do we see?

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If you were able to identify.

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This little guy.

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Spot on so this is a new Tracer radio

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Tracer uptake Focus that's adjacent

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to the right bronchus into medius with potential

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lymph node metastasis.

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There's also intense tracer activity in the

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anus and the rectum.

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Which may represent recurrence of rectal metastasis?

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And then there's a single small enhancing peritoneal nodule.

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It's too small for complete characterization but concerning for

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earlier recurrence of the peritoneal metastasis.

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So we have uptake in the right bronchus intermedius.

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Lymph node. We see radio Trace optic

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in the anus and the rectum and then we see a little enhancing pattern

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nodule which is what we're seeing right here.

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So the patient scheduled for CT guide of

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biopsy of the peritoneal because that steamed to speed the most

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amenable site for percutaneous tissue

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sampling by the IR Department.

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So the time of biopsy Scout CT successfully

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visualizes the patient's peritoneal nodule on the

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right side.

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So here we see this little nodule.

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adjacent to the anterior abdominal

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wall

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and that is targeted for biopsy.

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So what we see here is a series of Acquisitions obtained

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during CT fluoroscopy as

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the needle is advanced.

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So the corn needle biopsy of the patient's peritoneal is

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actually completed without complication.

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Samples are starting formalin and sent for pathological analysis.

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So what is the path report real?

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It demonstrates. Actually, I have no carcinoma a few

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days later and it's actually consistent with recurrent spread

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of the patient's primary lung cancer to the

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peritoneum very unfortunate.

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So in conclusion, the patient's biopsy samples

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were used for further molecular testing Foundation medicine

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testing in this particular case to determine the patient's

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eligibility for ongoing clinical trials. The patient

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was ordered for an additional brain MRI to

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rule out intracranial metastasis.

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The patient continues to follow up with her oncology team and she

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continues to be at the time of preparation of

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this material on chemotherapy.