PET-CT Report Summary

What is this scan?

Key Findings

🫁 LUNGS (Most Important Finding)

• A large, spiculated (spiky-edged) soft tissue mass is present in the upper lobe of the right lung, measuring approximately 4.0 × 5.9 × 3.5 cm — roughly the size of a golf ball.
• It has a very high SUVmax of 12.0, which is strongly suggestive of a primary malignant (cancerous) tumour.
• The mass is pressing against the right oblique fissure and encasing the subsegmental bronchi (airways), causing consolidation (partial collapse/fluid) nearby.
• It extends toward the parahilar region (near the lung root) and is abutting the right main bronchus and right paratracheal lymph nodes.

🔴 LYMPH NODES (Likely Spread to Nearby Nodes)

• A right lower paratracheal lymph node (in the chest, near the windpipe) is enlarged at ~3.8 × 2.8 cm with SUVmax 14.5 — this is highly suspicious for cancer spread (metastasis).
• Several other mediastinal lymph nodes (paraaortic, AP window, subcarinal, right hilar) show mild FDG activity (SUVmax ~5.1) — the radiologist considers these possibly inflammatory, but metastasis cannot be excluded.

🧠 BRAIN

• No brain metastases seen on PET-CT. However, the report notes that brain MRI should be done if clinically suspected, as PET-CT can miss small brain lesions.
• Age-related brain atrophy (normal for 76 years).

🔄 REST OF THE BODY — No Spread Detected

• Liver: Mild fatty infiltration (common finding); no cancer deposits.
• Spleen, Pancreas, Adrenals: All normal.
• Kidneys: Simple benign cysts (non-cancerous); otherwise normal.
• Abdomen/Pelvis lymph nodes: One small portocaval node seen, likely inflammatory.
• Bowel, Stomach: Unremarkable.
• Bones: Degenerative spine changes, dense sclerosis in right femur neck (likely benign). No bone metastases.
• Prostate: Post-TURP changes (prior surgery). Otherwise unremarkable.

Other Incidental Findings

• Atherosclerotic calcification in the aorta (expected at this age).
• Fatty degeneration of right masseter muscle (jaw muscle).
• Dental implants causing image artefact.
• Blood glucose at time of scan: 124 mg/dL (mildly elevated — important to note as it can slightly reduce scan sensitivity).

Radiologist's Opinion (Dr. Sudip Dey)

1. Primary lung cancer in the upper right lobe — likely a primary malignant tumour (the word "mitotic" in the report is used in the Indian radiology context to mean "neoplastic/cancerous")
2. Right lower paratracheal lymph node metastasis — cancer has likely spread to this nearby lymph node
3. Other mediastinal lymph nodes — likely inflammatory, but metastasis cannot be ruled out
4. No distant (far) metastases detected elsewhere in the body

What This Means — Next Steps

Urgently Recommended Actions:

1. Tissue Biopsy (most important) — A CT-guided biopsy, bronchoscopy, or EBUS (endobronchial ultrasound-guided biopsy) is needed to confirm whether this is cancer and what type (adenocarcinoma, squamous cell, etc.). This determines all treatment decisions.
2. Brain MRI — To rule out small brain metastases not visible on PET-CT.
3. Molecular/Genomic Testing — If cancer is confirmed, tissue should be tested for EGFR, ALK, PD-L1, and other markers, as these guide targeted therapy and immunotherapy options.
4. Pulmonary Function Tests (PFTs) — To assess lung reserve, especially if surgery is being considered.
5. Multidisciplinary Team (MDT) Consultation — Oncologist, pulmonologist, thoracic surgeon, and radiation oncologist should review the case together.

⚠️ Important Note