Bookmark and Share
Click 76 year-old female with newly diagnosed adenocarcinoma of the rectum. Images were acquired on a Siemens SOMATOM Sensation 16 CT Scanner with settings of auto mA, 120.00 kV, and 3.00 mm slice thickness. Approximately 90 ml of Ultravist 300 intravenous contrast and 900 ml of Readi-Cat 2 oral contrast were administered. Images in the delayed excretory phase were acquired 5 minutes after injection of intravenous contrast. CT images of the abdomen and pelvis demonstrate a 1.5 x 1.0 cm soft tissue mass arising from the right posterior bladder wall near the right ureteral insertion and a 1.5 x 1.0 cm soft tissue mass in the left renal pelvis; both suspicious for urothelial neoplasm.

Click 76 year-old female with adenocarcinoma of the rectum. The scan was performed one week after the bladder mass biopsy and approximately three weeks after the CT scan in Figure 1. Whole-body contrast enhanced CT scan was acquired on a Siemens Biograph 6 PET/CT system. CT scan settings were auto mAs, 130 kV, and 5 mm slice thickness. Contrast agents consisted of 75 ml of Ultravist 300 intravenous contrast and one 450 ml bottle of Readi-Cat 2 oral contrast. CT images acquired 70 seconds post contrast injection. CT images demonstrate two nodules of mixed confluence in the right upper lobe of the lungs and bilateral small ground-glass lung nodules. These findings were suspicious for lung malignancy of bronchoalveolar carcinoma - adenocarcinoma type. In addition, a rectal mass is seen, consistent with known rectal malignancy. A 1.1 cm solid lesion in the left renal pelvis is also visualized. This mass was suspicious for urothelial neoplasm. Lastly, bladder perforation is seen.

Click 76 year-old female with adenocarcinoma of the rectum. The scan was performed one week after the bladder mass biopsy and approximately three weeks after the CT scan in Figure 1. Whole-body PET scan was acquired on a Siemens Biograph 6 PET/CT system approximately 60 minutes following the intravenous administration of 13.2 mCi of FDG. The patient's blood glucose level was 131 mg/dl at the time of the FDG injection. PET images demonstrate very mild FDG uptake with maximum SUV of 0.8 corresponding to the two nodules of mixed confluence in the right upper lobe seen on CT. Bilateral small ground-glass lung nodules do not demonstrate any discrete metabolic activity. These findings are suspicious for lung malignancy of bronchoalveolar carcinoma - adenocarcinoma type. Rectal mass seen on CT demonstrates hypermetabolic activity with maximum SUV 8.5, consistent with known rectal malignancy. The metabolic activity of the 1.1 cm solid lesion in the left renal pelvis seen on CT could not be assessed due to normal excretion of FDG in the renal collecting system, however this mass is suspicious for urothelial neoplasm. Lastly, there is extravasation of radioactive urine in the region of the focal bladder perforation seen on CT.

Click 76 year-old female with newly diagnosed adenocarcinoma of the rectum presented for a follow-up noncontrast CT examination six hours after bladder perforation was discovered on PET/CT examination performed earlier the same day. Foley catheter had been placed immediately after bladder perforation was recognized on PET/CT. CT images were acquired on a Siemens SOMATOM Sensation 64 CT scanner with settings of auto mAs, 120 kV, and 3.0 mm slice thickness. Follow-up noncontrast CT scan of the abdomen and pelvis demonstrates extravasated contrast around the bladder filling the space of Retzius superiorly and the pelvic sidewalls laterally.