0:01

This is a 54-year-old male that has a tongue mass

0:05

and the F-D-G-P-C-T was performed

0:08

for staging here in the meep.

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Uh, we can see there are several abnormal findings

0:15

that we're gonna go through.

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We're gonna start with the head

0:19

and neck portion of the exam.

0:22

As you can see here, there is very intense tracer uptake

0:26

along the right side of the tongue,

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extending from the base all the way anteriorly.

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The SUV max in this area is

0:39

up to 13.2,

0:42

and this corresponded with the massine on physical exam

0:47

for head and neck cancer.

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It's always important

0:51

to mention in your report if there is evidence of

0:55

midline crossing because that changes management

1:00

and then the likelihood

1:01

of having bilateral novel disease increases.

1:06

In this case, you can see

1:07

that the mass is seen at the center

1:09

of the tongue anteriorly.

1:11

So, uh, we should mention that in the report.

1:15

In terms of novel disease, well there are multiple, uh,

1:20

lymph nodes that are involved.

1:22

The ones that show higher FG optic are on the right

1:27

and these were, uh, highly suspicious for involvement.

1:33

They extend from level two B.

1:36

You can see here on the CT

1:40

all the way down to level three,

1:44

the supraclavicular regions are clean.

1:48

There are some prominent left-sided lymph nodes

1:52

that show very mild racor uptake.

1:54

That should be included in the report as these could

1:59

represent additional areas of early disease.

2:03

So, going down to the mein, we see

2:08

that there are several, several ly FDG lymph nodes,

2:13

but the largest, uh, measures up to seven centimeters

2:20

and they have uptake

2:21

that is just slightly greater than, uh, blood pool.

2:24

We find in the lungs that there's multiple areas

2:27

of patchy ground glass opacities bilaterally,

2:31

but more so on the left morphologically.

2:35

It looks like consolidation

2:39

that is most likely related to aspiration

2:42

and possibly infection rather than disease.

2:47

They are all ground glass. There's no discrete lung nodules.

2:52

In cases with head

2:53

and neck masses, it is common to see

2:57

that patients aspirate.

2:59

So these lung findings, uh, are common to see.

3:03

On the remaining part of the exam, we can see

3:06

that there is an intense area of uptake that, uh,

3:09

localizes to the liver.

3:11

Taking a closer look, we see

3:14

that this lesion is a slightly hypo density,

3:16

doesn't have very defined borders,

3:19

but this is consistent with the liver metastasis.

3:25

So to recap this case, uh, we have a right-sided tongue

3:29

mass with multiple right-sided

3:34

cervical lymph nodes that are involved at least

3:38

one in the left that is suspicious.

3:42

And also a right hepatic lesion

3:45

that is also most likely metastatic in the chest.

3:49

We have multifocal bilateral pulmonary opacities

3:55

as well as reactive lymph nodes in the mediastinum

3:59

that are most likely related to aspiration

4:02

or aspiration related infection.

4:05

Another differential could be multifocal pneumonia.