Clinical History

The patient is a 48 year-old male with known metastatic colon carcinoma who is also S/P right hepatic lobectomy.

Technique

The patient was administered 5.5 mCi of Indium 111 Oncoscint and whole body imaging, as well as SPECT imaging of the abdomen was obtained 4 and 6 days post injection. SPECT imaging of the pelvis was also obtained 6 days post injection.

Findings

The whole body images on Day 4 and Day 6 demonstrates normal physiologic uptake of the radiolabeled Oncoscint in the liver, spleen and bone marrow. In addition, there is a linear area of uptake in the right abdomen, best seen on the anterior views. Note is made of prior partial resection of the right lobe of the liver. SPECT imaging of the abdomen on Day 4 and SPECT imaging of the abdomen and pelvis performed on Day 6 demonstrates this linear area of increased activity in the right abdomen to be far anterior in the region of the anterior abdominal wall. The area of abnormal uptake begins in the right lower quadrant just above the right iliac crest and extends to the anterior margin of the liver. In addition, there is an area of more mild increased uptake seen very superficial, in the posterolateral abdominal wall on the right at the mid hepatic level which could represent additional disease in the abdominal wall or subcutaneous tissues. SPECT imaging of the liver demonstrates central photopenia which may represent hepatic portal structures, however, recurrent metastatic disease cannot be excluded. SPECT imaging of the pelvis demonstrates a small area of abnormal increased uptake in the right pelvis near the pelvic wall which is also suspicious for an area of metastatic disease, possibly representing an area of pelvic adenopathy. No definite abnormal uptake is identified in the chest on the whole body images.

Impressions


1.WHOLE BODY INDIUM 111 ONCOSCINT SCAN DEMONSTRATING AN AREA OF LINEAR INCREASED UPTAKE IN THE RIGHT ABDOMEN FAR ANTERIOR, MOST LIKELY RELATED TO THE ANTERIOR ABDOMINAL WALL WHICH EXTENDS FROM THE RIGHT LOWER QUADRANT TO THE ANTERIOR MARGIN OF THE LIVER. THIS MOST LIKELY REPRESENTS METASTATIC DISEASE EITHER TO THE ABDOMINAL WALL OR PERITONEAL SURFACE. CORRELATION WITH CT EXAMINATION OF THE ABDOMEN IS RECOMMENDED.

2.AREA OF FOCAL INCREASED UPTAKE OF RADIOLABELED ONCOSCINT IN THE RIGHT PELVIS NEAR THE PELVIC WALL SUSPICIOUS FOR METASTATIC ADENOPATHY.

3.ILL-DEFINED SMALL AREA OF INCREASED LOCALIZATION IN THE POSTEROLATERAL ABDOMINAL WALL ON THE RIGHT, AS DESCRIBED, ALSO SUSPICIOUS FOR AN AREA OF METASTATIC DISEASE.

4.PHOTOPENIC DEFECT IN THE CENTRAL PORTION OF THE LIVER WHICH MAY REPRESENT PORTAL STRUCTURES, HOWEVER, RECURRENT HEPATIC METASTASIS CANNOT BE EXCLUDED. CORRELATION WITH CT STUDY OF ABDOMEN WITH PRE CONTRAST DYNAMIC AND POST CONTRAST IMAGES OF THE LIVER WOULD BE USEFUL FOR FURTHER EVALUATION.

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