How to manage chronic pain in pulmonary sarcoidosis?

Question

I have chronic pain with pulmonary sarcoidosis with possible bone involvement. Can you please explain the impressions from my recent FDG PET/CT? Impression:

1. Comparing to the FDG PET/CT done before 8 years, metabolic and anatomic improvement in scattered multiple pulmonary nodules and the mediastinal and hilar lymphadenopathy. No suspicious residual or new hypermetabolic lung lesion or lymphadenopathy is noted. Most of the lung nodules have transformed into calcified granulomas and the hilar and mediastinal lymph nodes have become more calcified than on the prior examination.

2. A small and mildly hypermetabolic focus (SUV max of 5.2) in hepatic segment 2 with no corresponding anatomic lesion on the noncontrast CT. This is nonspecific and may still be a normal variant uptake. Dedicated imaging of the liver may be performed with CT or MRI as clinically warranted.

3. Heterogeneous radiotracer distribution in the visualized bones, which is most notable in the spine with no corresponding osseous lesions. This may be related to the previously noted bone marrow nodules. Correlation with bone marrow biopsy may be considered. Subtle sclerotic changes in the posterior right ninth and 10th ribs with no abnormal FDG metabolic activity. These are nonspecific and may be related to prior trauma. Attention on follow-up is recommended.

4. Nonobstructing bilateral renal calculi, most significant on the left. A 3-mm calculus at the right ureter pelvic junction with no evidence of obstruction.

Answer 1

Hi,

Thanks for writing in to us.

The FDG PET CT findings are compared to a previous scan done before 8 years.

1. In the recent scan, the previous lung nodules have become calcified and there is an improvement in the chest findings when compared to the previous scan. There is also mention of increased calcification of the lymph nodes in the mediastinum and this might suggest resolving changes.

2.There is a small area of increased activity in the liver without any lesion in the non contrast CT. Most likely this is a benign focus of variant uptake. However a CT scan or MRI scan with contrast for detailed evaluation of liver may be done if needed due to your clinical condition.

3. There is heterogeneous activity in the bones and is more prominent in the spine and can be the areas of previous bone marrow nodules given in an earlier report. There is sclerotic activity (increased calcium deposition) in the right 9th and 10th ribs and this is probably from an old trauma.

4. You have tiny stones in both kidneys largest 3 mm in size but not causing obstruction to urine outflow. Regards,