61-year-old male with destructive bony lesion L5/S1. Evaluate unknown primary malignancy. History of hemachromatosis and diabetes. The recent PET examination demonstrates no pathologic foci of increased radiotracer accumulation to indicate FDG avid tumor in the neck, chest, abdomen or pelvis. Specifically, the region of L5/S1 is negative on FDG-PET.On the recent PET scan examination show moderate to markedly increased metabolic activity throughout the entire colon suggesting a nonspecific infectious or inflammatory colitis.CHEST:LUNGS AND PLEURA: Mild left lower lobe volume loss and atelectatic changeMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: There is hepatosplenomegaly. The liver measures 20 cm craniocaudally, and the spleen measures approximately 14 cm. The hepatic parenchyma is hypodense relative to the spleen suggesting fatty infiltration. There are small calcifications in the liver, probably due to old granulomatous disease. Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral renal cortical hypodensities compatible with simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes in the spineOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis, without evidence of diverticulitis. No specific abnormality was found in the colon to correspond with the area of increased uptake on the recent PET scan examination.BONES, SOFT TISSUES: Multilevel degenerative disk disease. Abnormal mass lesion infiltrates the spinal column at L5-S1, seen best at axial image 150/222. These findings are compatible with an aggressive process, such as infection or malignancy. No significant interval change since recent MRI and CT scans of the lumbosacral spine.OTHER: Prominent left varicocele at axial image 220/222.
Hepatosplenomegaly. Probable fatty infiltration of the liver. No significant interval change in the L5-S1 aggressive process seen on recent CT and MRI examinations. No local neoplasm. Left varicocele. Findings are discordant with PET-CT exam regarding the colon, where no abnormality was found. 