Accessory fissures in the lungs are common congenital variations, usually detected as incidental findings in radiographs or CT scan. Accessory fissures can act as an anatomic barrier to the spread of inflammatory or neoplastic disease, as well as due to the variant anatomy, mimic lesions. It is important to recognize the presence of accessory fissures, as they affect surgical planning of pulmonary lobectomy and segmentectomy. Accessory fissure in the right upper lobe other than due to the anomalous course of azygos vein is very rare. We report a case of non-azygos accessory fissure, between the apical and the anterior segments of right upper lobe, along with superior and inferior accessory fissures in the right lower lobe.
A 62-year-old male with a history of radical prostatectomy for a Gleason 9 (4 + 5) pT3N0Mx prostate cancer presented with rising prostate-specific antigen of 9.0 ng/dl. A contrast-enhanced computerized tomography (CT) revealed an enhancing left upper pole renal mass and aortocaval lymph nodes. Indium (In)-111 Capromab Pendetide (ProstaScint®) single-photon emission computerized tomography-CT showed abnormal increased uptake in left renal mass and aortocaval lymph nodes with no uptake in the prostate bed or pelvic lymph nodes. He underwent left radical nephrectomy and dissection of aortocaval lymph nodes. Pathology showed renal clear cell carcinoma and metastatic prostate adenocarcinoma involving aortocaval lymph nodes. Our case demonstrates a rare combination of two different malignancies, prostate cancer and clear cell renal cell cancer, showing In-111 ProstaScint® uptake. Though ProstaScint® uptake in renal cell carcinoma and in metastatic aortocaval lymph nodes from prostate cancer may be seen in clinical practice, this combination has not been reported previously.
We report a patient with history of Hodgkin lymphoma. Six months after treatment, 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography and/or computed tomography ([18F] FDG PET/CT) scan showed abnormal uptake in right axillary lymph nodes concerning for recurrence. In addition, PET/CT showed a new hypermetabolic skin lesion overlying the right scapula. Clinical evaluation was consistent with shingles, and the patient was treated with valacyclovir. Subsequent PET/CT scan was normal with no evidence of lymphoma. Although there have been reported cases of abnormal FDG in nodes or in skin due to herpes zoster, our case is unique in the literature in that the PET/CT demonstrates abnormalities involving both the skin and associated lymph nodes. The possibility of false positive uptake, not because of recurrent malignancy, must always be considered when abnormal FDG uptake is noted in the follow-up of oncology patients. Careful review of the scan and correlation with clinical findings can avoid false positive interpretation and facilitate patient management.
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