A 71 yrs old male was admitted with increasing shortness of breath and was found to have a large left side pleural effusion. Thoracentesis revealed an exudate with many RBCs and the cytology was negative. CT scan showed a large left pleural effusion, circumferential pleural thickening, and a posterior mediastinal mass. EUS guided FNA of the mediastinal mass revealed adenocarcinoma.

Whole body PET-CT showed: FDG avid left lung pleural thickening, hypermetabolic right paratracheal lymphadenopathy (SUV 5.1), and focal hypermetabolism in the thickened lower esophagus (SUV 15.7). EGD revealed esophageal adenocarcinoma. Incidentally seen on PET-CT is an intensely FDG avid (SUV 36.7) fluid density mass in the left scrotum, from inguinal herniation of the urinary bladder.

This case was compiled by Dr. Aaron Baxter, BCM