PMC9174522_01
Computed tomography (CT) of the chest, abdomen, and pelvis from April 2021 demonstrating bilateral pulmonary nodules (A, B) and an L2 lesion (C) consistent with metastatic disease.
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Due to the nonspecific pulmonary nodules concerning for metastatic disease on prior imaging, a restaging CT chest/abdomen/pelvis was performed, and unfortunately, it revealed new and enlarging bilateral pulmonary nodules consistent with pulmonary metastatic disease and a sclerotic L2 vertebral body osseous lesion consistent with bone metastatic disease (Figure 1).
Positron emission tomography (PET) from August 2021 after 4 cycles of pembrolizumab demonstrating increase in size and number of FDG-avid pulmonary nodules (A-1-C-1) and FDG-avid sclerotic L2 lesion (D-1) and from November 2021 after 3 cycles of enfortumab vedotin demonstrating near complete response of FDG-avid pulmonary nodules (A-2-C-2) and FDG-avid L2 lesion (D-2).
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Unfortunately, a follow-up PET CT scan in August 2021 showed progression in the lungs with numerous bilateral hypermetabolic solid pulmonary nodules that were increased in number and size and raised concern for malignant pleural effusion (Figure 2).
Timeline of events across the treatment course of the patient.
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The previous effusions were smaller and no longer PET-avid, and the previously seen multiple pulmonary nodules and sclerotic L2 lesions were no longer visible (Figure 3).