Hey everyone... my dad is 63, and during a routine checkup on January 17th, they found out his blood sugar was through the roof, way over 22. He’s been kept in for observation and running all sorts of tests because the doctors initially suspected pancreatic cancer, but then the CT scan threw a curveball: the pancreas looks fine, but they spotted two different growths in his lungs. According to the CT, one smaller lesion is just a hamartoma, but the other one is "spicular" and measures about 3.4 cm... so they suspect a tumor. They did a bronchoscopy biopsy, which came back negative for cancer cells, and then they biopsied the lesion itself, which also came back negative for malignant cells. After that, he had a PET-CT scan, and here is the diagnosis:
Preliminary diagnosis and clinical question
Left lung lobe infiltration, Diabetes mellitus, referred by Dr. Janevski for diagnostic confirmation and staging
PET Scan
6.7 mmol/L
Findings
Tomograms were performed from the base of the skull down to the proximal parts of the thighs.
A low-dose CT was also conducted to correct attenuation and anatomical localization of the metabolically active changes.
No pathological uptake of the radiopharmaceutical was seen in the cervical, axillary, or mediastinal lymph nodes.
Pathological radiopharmaceutical uptake is visible in the consolidation of the left upper lung lobe, centrally translucent, measuring 1.9x1.4
cm (SUV max 6.32). Increased radiopharmaceutical uptake is also seen in a nodule in the right lower lung lobe (SUV max 2). In
the remaining lung parenchyma, there is no pathological uptake of the radiopharmaceutical.
Radiopharmaceutical uptake is noted in a formation in the left adrenal gland (SUV max 5.46), with an intensity similar to the uptake in the liver
parenchyma (SUV max 5.86), which aligns with the CT from early 2023 where this formation was characterized as an adenoma.
No pathological uptake of the radiopharmaceutical was observed in the abdominal, pelvic, or inguinal lymph nodes.
Diffuse, intense radiopharmaceutical uptake is visible in the intestinal loops, which makes analysis difficult—this is likely a side effect of metformin therapy.
An endoscopic exam should be performed if clinically indicated.
No pathological uptake of the radiopharmaceutical was detected in the visualized parts of the skeletal system.
Impression
Pathological glucose analog metabolism in the consolidation of the left upper lung lobe.
Metabolically active nodule in the right lower lung lobe. So what does this actually mean in the end? Is it some kind of carcinoma, or just inflammation? Honestly, we’re totally lost now. 🤔
Preliminary diagnosis and clinical question
Left lung lobe infiltration, Diabetes mellitus, referred by Dr. Janevski for diagnostic confirmation and staging
PET Scan
6.7 mmol/L
Findings
Tomograms were performed from the base of the skull down to the proximal parts of the thighs.
A low-dose CT was also conducted to correct attenuation and anatomical localization of the metabolically active changes.
No pathological uptake of the radiopharmaceutical was seen in the cervical, axillary, or mediastinal lymph nodes.
Pathological radiopharmaceutical uptake is visible in the consolidation of the left upper lung lobe, centrally translucent, measuring 1.9x1.4
cm (SUV max 6.32). Increased radiopharmaceutical uptake is also seen in a nodule in the right lower lung lobe (SUV max 2). In
the remaining lung parenchyma, there is no pathological uptake of the radiopharmaceutical.
Radiopharmaceutical uptake is noted in a formation in the left adrenal gland (SUV max 5.46), with an intensity similar to the uptake in the liver
parenchyma (SUV max 5.86), which aligns with the CT from early 2023 where this formation was characterized as an adenoma.
No pathological uptake of the radiopharmaceutical was observed in the abdominal, pelvic, or inguinal lymph nodes.
Diffuse, intense radiopharmaceutical uptake is visible in the intestinal loops, which makes analysis difficult—this is likely a side effect of metformin therapy.
An endoscopic exam should be performed if clinically indicated.
No pathological uptake of the radiopharmaceutical was detected in the visualized parts of the skeletal system.
Impression
Pathological glucose analog metabolism in the consolidation of the left upper lung lobe.
Metabolically active nodule in the right lower lung lobe. So what does this actually mean in the end? Is it some kind of carcinoma, or just inflammation? Honestly, we’re totally lost now. 🤔