ACR Codes: 9.3
-History: 22 y/o female presented to the ENT clinic with an enlarging left supraclavicular mass.
-Radiologic findings:
Selected axial CT images of the chest demonstrate poorly defined abnormal soft tissue in the left supraclavicular region and mediastinum.
Coronal SPECT images after the administration of 9.7 mCi of Gallium-67 citrate scan obtained 3 days after injection demonstrate abnormal radiotracer accumulation in the mediastinum and left supraclavicular region.
-Differential Diagnosis: Gallium-67 citrate is not tumor specific and can accumulate in various disorders, which include:
· Infections (soft tissue and osteomyelitis)
· Skeletal trauma or repair
· Early radiation therapy sites (probably from inflammation)
- Diagnosis: Hodgkin's Lymphoma (nodular sclerosing) confirmed with FNA.
- Discussion: Hodkin's disease is a lymphoproliferative neoplasm of bimodal distribution - 15 to 35 and above 50 yrs. The four histologic subtypes of Hodgkin's lymphoma are: nodular sclerosing (most common), mixed cellularity, lymphocyte depleted and lymphocyte predominant. The first two are gallium avid. Gallium imaging is used in most patients with Hodgkin's disease for staging and to asses response to therapy. Persistent gallium uptake during and after treatment is a poor prognostic sign and suggests a high risk for relapse. With time, FDG-PET scanning will probably replace gallium scanning in lymphoma patients. FDG-PET has the advantages of shorter exam time, lower radiation dose, better tumor uptake in low-grade lymphomas, and easier evaluation of intra-abdominal activity that gallium studies (2).
Reference(s): 1. Donohoe KJ, Van den Abbeele AD. Teaching Atlas of Nuclear Medicine. Thieme -NY. 2000.
2. Wallis, J. In Disclosures - Assesing Lymphoma and Myeloma with PET Scanning. 49th Annual Meeting of the Society of Nuclear Medicine. June 15-19, 2002.
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