NUCLEUS DIGITAL PET &MOLECULAR First &Only Advanced Digital PET Scan&

Gamma Camera Centre in Western Maharashtra

IMAGING CENTRE & North Karnataka

Centre of Excellence For Molecular el Nuclear Imaging.

NAME: ANANDA JADHAV

AGE/SEX: 53YRS/M
DR. KAUSTUBH AURNGABADKAR
REF BY: DATE: 03.04.2024

WHOLE BODY 18F-FDG PET-CT SCAN

Procedure:

Fusion PET/CT imaging was pertormed on uMI 550 digital PET-CT system from the head to toes 102 mins after IV
administration of 5.04 mCi of F-18 fluorodeoxyglucose (FDG). Contrast-enhanced CT was performed for the
Durpose of attenuation correction and anatomical correlation. Sr. Creatinine level was 0.9 mg/dl (02/04/2024).
Blood glucose level was 106 mg/dl prior to scan. SUV values, wherever mentioned, have been measured in gm/ml.
Note: All tumors are not FDG avid. In the absence of metabolically active disease reported on the scan, if there are other evidences to suggest
presence of disease, complimentary investigations should be undertaken. Investigations have their limitations. Solitary pathol ogical/ radiological
and other investigations never confirm the final diagnosis of disease. They help in diagnosing the disease in correlation to clinical symptoms &
other related tests. Please interpret accordingly.
FDG PET/CT is not a sensitive modality for brain metastases, consider MRI brain if clinically indicated.

PET-CT Scan findings:

Physiological uptake of radiotracer (FDG) is seen in the visualized brain parenchyma, tonsillar region, vocal cords, myocardium,
gut, pelvicalyceal system and bladder.

Head &Neck:
Physiological FDG uptake is noted in the head and neck.
No significant FDG avid cervical or supraclavicular nodes are seen.

Thorax:
No pleural or pericardial effusion seen.
No significant FDG uptake is noted in the lungs.
Increased FDG uptake is seen in the subem-sized subcarinal node (SUVmax 5.8) - likely inflammatory.
No significant FDG-avid axillary or hilar nodes are seen.

Abdomen & Pelvis:

No abnormal FDG uptake is seen in liver, spleen, pancreas and adrenals.
No significant FDG uptake is seen in the subcm-sized hypodense nodule in left adrenal gland - Ilikely
benign.
FDG distribution in the bowel loops is in a physiological pattern.
Low grade FDG uptake is seen in oblong right external iliac node (SUVmax 4.4) - inflammatory.
No ascites seen.
No significant FDG-avid abdominal or inguinal nodes are seen.

Bones, Bone marrow and Soft tissues:

Low grade diffuse FDG uptake is seen in marrow of axial and appendicular skeleton - secondary to
reticuloendothelial stimulation.
No demonstrable abnormal FDG uptake noted in the bones and soft tissues.

Page 1 of 2

Dr. Shreyas Kudachi Dr. Kulgod Santosh Dr. R. C. Chinchanikar

Dr. Manjeet Kulkarni
MRB.S. D.M.R) MESterS In Oncologic Imaging, Nuclear Physician
M.B.B.S., D.M.R.D., D.N.B. (Radiology) M.B.B.S., D.M.R.D., D.N.B.(Radiology) M.B.B.S., M. D. (Pathology
70/A/4/3/4, Ujlaiwadi, Tal. Karveer, Dist. Kolhapur-416003. Email: ninthaxisdiagnosis@gmai
 NUCLEUS DIGITAL PET&MOLECULAR First&OnlyAdvanced Digital PET Scan&
Gamma Camera Centre in Western Maharashtra

IMAGING CENTRE &North Karnataka

Centre of Excellence For Molecular el, Nuclear Imaging.

NAME: ANANDA JADHAV AGE/SEX: 53YRS/M

DR. KAUSTUBH AURNGABADKAR DATE: 03.04.2024
REF BY:

Extremities:

No demonstrable
abnormal FDG uptake noted in both the lower limbs.

OPINION
H/o slurring of speech, for evaluation.
No significant metabolically active disease anywhere in the whole-body survey.

Maeyan
DR. SHREYAS KUDACHI
MBBS, DRM, Masters in Oncologic Imaging
Consultant, Nuclear Medicine & PET-CT

Page 2 of 2

Dr. Kulgod Santosh Dr. R.C.Chinchanikar

Dr. Shreyas Kudachi Dr. Manjeet Kulkarni
M.B.B.S. D.M.R.D. D.NB. (Radiology) MBBS. DMRD. DNB (Rafiolog M.B.8.S. M. D.(Panology)
M.R) Masters in Oncologic Imaging,NuclearPhysician
Contact: 9936 51 7474 9636588181
/3/4, Ujlaiwadi, Tal. Karveer, Dist. Kolhapur-416003. Email: [email protected]
 DIAMOND SUPERSPECIALITY HOSPITAL
(A Venture of Kolhapur Super-Speciality Medical Centre)
184/1,Near Acharya Vidyanand Bhavan, 'e' Ward,
Nagala Park kolhapur-416002. Ph:0231-2667044/45/46,2668811,2667244

Discharge Summary
Patient Name ANANDA JAGANNATH JADHAV

Age 53 Sex Male

Date of Admission 02-04-2024 Date of Discharge 04-04-2024
Address a/p-helgaon tal-karad dist-satara
Doctor Name Dr. Kaustubh Aurangabadkar Followup Date 09-04-2024
IPD No. 66202020413

Diagnosis:
SUBACUTE DYSARTHRIA
UNPROVOKED LAUGHTER
LEFT UPPER LIMB PROXIMAL WEAKNESS WITH FASCICULATIONS
?MND.

****

Presenting Illness:
A S3 YEARSs OLD MALE PATIENT ADMITTED WITH DIFFICULTY IN SPEAKING, LEFT UPPER LIMB
WEAKNESs, SLOWNESS OF ACTIVITIS, TWITCHING OVER LEFT UPER LIMB.

O/E:BP--120/90MMHG, PULSE--79/MIN, SPO2--98%.

S/E:CVS-Sis2 HEARD, RS--AEBE CLEAR, P/A--SOFT

CNS: CONSCIOUS AND ORIENTED
MOVING ALL FOUR LIMBS
SPASTIC DYSARTTHRIA
BRISK REFLEXES, MLID WEAKNESS LEFT TRICEPS, FASCICULATIONS OVER LEFT ARM.

Past History:
NOT A CASE OF DM/HTN/IHD
HO.- PATIIENT CONSULTED WITH DR.KEDARI PRASAD KULKARNI SIR, INVESTIGATIONS DONE
1) CBC/RFT/BSL/TSH -NORMAL , HIV- NEGATIVE
2) TOTAL PROTEIN - 7.8, ALBUMIN- 4,4
3) IPTH -21 (15-65 NORMAL)
4) PROTEIN ELECTROPHORESIS - MONOCLONAL BAND NOT SEEN
5) NCS (5/2/2024) B/L ? ANT. MOTOR AXONOPATHY IN UPPER AND LOWER LIMB. ?ANT. HORN CELL
DISEASE.
6)MRI BRAIN (15/1/2024)- ISCHEMIC CHANGES IN B/L FRONTO-PARITAL WHITE MATTER.

Course in Hospital:
A MALE PATIENT ADMITTED WITH ABOVE MENTIONED COMPLAINTS. AFTER INITIAL ASSESSMENT
ALL NEEDED INVESTIGATIONS DONE.
 DIAMOND SUPERSPECIALITY HOSPITAL
(A Venture of Kolhapur Super-Speciality Medical Centre)
184/1,Near Acharya Vidyanand Bhavan, 'e Ward,
Nagala Park kolhapur416002. Ph:0231-2667044/45/46,2668811,2667244.

TFT SHOWED RAISED LEVEL

BLOOD INVESTIGATIONS SHOWED TOTAL CPK-305.2 (NORMAL-25-308),
OF TSH (9,01)

NCS+EMG DONE ON 3/4/2024- REPORTS AWAITED

ANYWHERE INN
PET SCAN DONE ON 3/4/2024 NO SIGNIFICANT METABOLICALLY ACTIVE DISEASE
WHOLE BODY SURVEY.

ACETYL-CHOLINE RECEPTOR ANTIBODY -BELow 0.11.

PATIENT TREATED WITH NUTRITIONAL SUPPLEMENT, MUSCLE RALAXANTS AND OTHER SUPPORTIVE
MEASURES
PATIENT MONITORED FOR VITALS, NEUROLOGICAL DETERIORATION, TEMP,

PATIENT CLINICALLY AND SYMPTOMATICALLY STABLE HENCE DISCHARGED WITH STABLE VITALS.

Treatment Given
TREATMENT GIVEN
INJ NERVZ/ ELDERVIT/THIAMINE IV OD 3 DAYS
INJ PAN 40MG STAT AND OD
INJ EMSET 4MG IV STATAND TID
TAB Q-NENS 500MG OD
CAP EVION 400MG HS
TAB RILUTOR 50MG HS

Remark

Treatment Advice
Medicine Name Drug Name Mor Eve Days Spl.Instruction
TABQNENS 500 MG
CAP EVION 400 MG
TAB RILUTOR 50 MG
CAP OMELIFE 20 MG

Remark:
F/U WITH DR AURANGABADKAR SIR AFTER 5 DAYS.

aeoineeiane

Issue:
 Mr. ANANDA JAGANNATH JADHAV Reference: DR.KAUSTUBH
Medical Laboratory Report
VID: 240087100143691
KOP Karveer.. AURANGABADKAR
Tel No 9999900000 Sample Collected At: Registered On:
Maxcare Lab 04/04/2024 08:31 PM
PID NO: P18824521451308
Mahalaxmi Apartment Gala No 203 Collected On:
Age: 53 Year(s) Sex: Male Rajarampuri 2nd Lane Kolhapur. 04/04/2024 8:14PM
Processing Location:- Metropolis Reported On:
Healthcare Ltd,Unit No409-416,4th
Floor, Commercial EBuilding-1,Kohinoor 05/04/2024 04:20 PM
Mall, Mumbai-70

Investigation Observed Value Unit Biological Reference Interval

AChR- Acetyl Choline Receptor below 0.11 nmol/L Negative: <0.40
Antibodies Borderline: 0.40-0.500
(Serum,EIA) Positive: > 0.50
Interpretation:
Positive result indicates possibility of Myasthenia Gravis (MG) in people who are symptomatic.
These antibodies can also be found in some other disorders like-
primary biliary cirrhosis, tardive
dyskinesia, autoimmune
thyroiditis, systemic lupus erythematous, thymoma without myasthenia, and amyotrophic lateral sclerosis.
Clinical Utility:

Acetyl Choline Receptor Autoantibodies is highly specific for the diagnosis of Myasthenia Gravis (MG).
in the majority of patients (-85%) antibodies against the muscle acetylcholine receptor (AChR) are detected, while 6%
antibodies against the muscle-specific kinase (MuSK) are detected.
In approximately 10% of MG patients no autoantibodies can be found with the classical diagnostics for AChR and MuSK
antibodies
The antibody titres be
can negative or not detectable in the first 12 months after the onset of symptoms of MG or during
immunosuppressant therapy.
The magnitude of the antibody titres correlates poorly with severity of MG and hence is not useful for predicting disease
activity.

Note:-. Positivity is observed in a few cases post covid due to molecular mimicry.
Associated Test: Musk Antibody (M0080)

References-
Vincent A, Newsom-Davis J. Acetyicholine receptor antibody as a diagnostic test for myasthenia gravis: resuits in 153
validated cases and 2967 diagnostic assays. J Neurol Neurosurg
Psychiatry 1985; 48: 1246-52.
Limberg PC, Hummel E, Relationship between changes in anti-acetylcholine receptor antibody concentration & disease
severityin myasthenia gravis. Ann NY Acad Sci 1981; 377: 859-61.
Garlepp MJ, Kay PH, Dawkins RL. The diagnostic significance of auto antibodies to the acetylcholine receptor. J
Neuroimmunol 1982; 3:337-50.
Muralidhar Reddy Y, B SK, Osman S, et alTemporal association between SARS-CoV-2 and
new-onset myasthenia gravis:
is it causal or coincidental?BMJ Case Reports CP 2021;14:e244146.
Lazaridis K, Tzartos SJ. Autoantibody Specficities in Myasthenia Gravis,
Implications for Improved Diagnostics and
Therapeutics. Front Immunol, 2020 Feb 14;11:212
Kit Insert

--
End of Report

Tests marked with NABL symbol are accredited by NABL vide Certificate no MC-2139; Validity till 01-06-2024

Page 1 of 1
Dr. ALAP CHRISTY
Head
MBBS, MD, PGDM-HC
-

METROPOLIS INNER HEALTH REVEA Clinca re hemistry

e g No.2020/12/6991
This &coemputer generuted medea dhagnastica mptit thot has been valdated by an Autiorued Medical PracntionerDactor. The report does net need C A P
The Pathology Specialist physicui sjguctare Resuits relate any to the sxumpie as received
Refer bs condfitios of veparting overtet red
 Medical Laboratory Report
Mr. ANANDA JAGANNATH JADHAV Reference: DR.KAUSTUBH VID: 240087199143891
KOP Karveer.. AURANGABADKAR
Sample Collected At: Registered Onc
TelNo9999900000 Maxcare Lab 04/04/2024 0831 PM
PID NO: P18824521451308 Mahataxmi Apartment Gala No 203 Colledted O
Age: 53 Year(s) Sex: Male Rajarampuri 2nd Lane Kolhapur 04/04/2024 2:14PM
Processing Location- Metropolis Reponed Oon
Healthcare Ltd, Unit No409-416,4th
Floor,Commercial Building-1,Kohinoor 05/04/2024 0420 PM
Mall, Mumbai-70

Investigation Observed Value Unit Biological Reference interval

AChR- Acetyl Choline Receptor below 0.11 nmol/L Negative: < 0,40
Antibodies
(Serum,EIA) Borderline: 040-0.50
Positive: >0.50
Interpretation:
Positive result indicates possibility of Myasthenia Gravis (MG) in people who are symptomatic
These antibodies can alsobe found in some other disorders like- primary biliary cirhosis, tardive dyskinesia, autoimmuns
thyroiditis, systemic lupus erythematous, thymoma without myasthenia, and amyotrophic lateral sclerosis.
Clinical Utility:

Acetyl Choline Receptor Autoantibodiesis highly specific for the diagnosis of Myasthenia Gravis (MG).
inthemajority of patients (-85%) antibodies against the muscile acetylcholine receptor (AChR) are detected, weile %
antibodies against the muscle-specific kinase (MusK) are detected.
Inapproximately 10% of MG patients no autoantibodies can be found with the dlassical diagnosics for AChR and MsK
antibodies
The antibody titres can be negative or not detectable in the first 12 months after the onset of syrmptoms cf MGr during
immunosuppressant therapy.
The magnitude of the antibody titres corelates poorly with severity of MG and hence is not useful for predicting disease
activity.

Note:- Positivity is observed in a few cases post covid due to molecular mimicy.

Associated Test: Musk Antibody (M0080)

References-
Vincent A, Newsom-Davis J. Acetylcholine receptor antibody as a diagnostic test for myasthenia gravis: resuts in 153
validated cases and 2967 diagnostic assays. J Neurol Neurosurg Psychiatry 1985; 48: 1246-52.
Limberg PC, Hummel E, Relationshipbetween changesin anti-acetylcholine receptor antibody concentration &disease
severity in myasthenia gravis. Ann N Y Acad Sci 1981; 377: 859-61.
Garlepp MJ, Kay PH, Dawkins RL. The diagnostic significance of autoantibodies to the acetylcholine receptor. J
Neuroimmunol 1982; 3: 337-50.
Muralidhar Reddy Y, B SK, Osman S,etalTemporalassociation between SARS-CoV-2 and new-onset myasthenia gravis
is it causal or coincidental?BMJ Case Reports CP 2021;14:e244146.
Lazaridis K, Tzartos SJ. Autoantibody Specificities in Myasthenia Gravis, Implications for Improved Diagnostics and
Therapeutics. Front Immunol, 2020 Feb 14;11:212
Kit Insent

-- End of Report --

Tests marked with NABL symbol are accrodited by NABL vide Certificate no MC-2138; Validitysll01-06-2024

Page 1 of1

Dr. ALAP CHRISTY

MBBS, MD, PGDMHC Head -

METROPOLS his cpuer

INNER HEALTH REVEABR2e
pyaca sgure Res dinse
rnedicn tudagte ho he hen bese seidated f
the sumpie cndefer ca
ty artAiornd
oie
ed e f ECAP
 DIAMVND SUPERSPECIALITY HOSPITAL
Medical Center LLP)
(Venture of Kolhapur Superspeciality
Mahaveer College, Nagala Park,
184 A/Part 1, E Ward, Near
0231-2667045
Kolhapur. Ph.: 0231-2667044/
PATHOLOGY REPORT

LABID:80 Sample Collection: 02/04/2024 20:26

80 020424

JADHAV Age : 53 Yrs. Sex: M Sample Received : 02/04/2024 20:26

Name:MR. ANANDA JAGANATH
Ref. By: DR. KAUSTUBH AURANGABADKAR Printed:03/04/2024 10:11 Report Released 02/04/2024 23:27

Sent By: Direct

COMPLETE BLOOD cOUNT

Test Result Unit Reference Range
Haemoglobin 13.3 g/dl 13.5-16.5 g/dl
w.B.C. Count 10070 cumm 4000-11000 /cumm
R.B.C. Count 4.74 millions/cumm 4.5-6.0 millions/cumn
RDW 13.2 11-14.5 %
PCV 38.8 40-52 % Platefet Gaph

MCV 82.0 80-96 f1

MCH 28.1 Pg 27-32 Pg
MCHC 34.3 gm/di 32.5-36 gm/di
Platelet Count 234000 /ul 150000-450000 /ul
PCT 0.210 0.08-1.00 %
MPV 9.1 fL 3-12 fL
RBC Gaph

Neutrophils 70.2 40-70 %

Lymphocytes 19.7 18-40 %
Eosoniphils 2.3 o 1-6%
Monocytes 6.9 2-10 %
Basophils 0.9 0-1 %
LIC% (Large Immature Cells) 0.5
Absolute Neutrophil Count 7030 /cmm 1500 8000/ cmm
(ANC)
Absolute Lymphocyte Count 1970 cmm 1000-4800/ cmm
Absolute LIC Count 0.05 10xE^3/uL
Absolute Basophil Count 90 10xE^3/uLL
Absolute Eosinophils Count 230 10xEA3/uL
Absolute Monocyte Count 700 10xE3/uL
Test done with FIVE PART DIFFERENTIAL CELL COUNTER
( HORIBA H 550 )
(Collected At: 02/04/2024 20:26:42, Received At: 02/04/2024 20:26:42, Reported At: 02/04/2024 23:27:44)

End Of Report-

ur. ProSapana Deshpande

DNE YPATHOLOEY) DPBpande
DNB Pathology), DPB
Reg No 2007040816
 DIAMYND(Venture
SUPERSPECIALITY HOSPITAL
of Kolhapur Superspeciality Medical Center LLP)
184 A/ Part 1, E Ward, Near Mahaveer College, Nagala Park,
Kolhapur. Ph.: 0231-2667044/0231-2667045
PATHOLOGYREPORT eo

80 020424 LABID:80 Sample Collectlon: 02/04/2024 20:26

Name : MR. ANANDA JAGANATH JADHAV
Age :53Yrs. Sex: M Sample Received :02/04/202420.26
Ref. By: DR. KAUSTUBH AURANGABADKAR Printed: 03/04/2024 10:11 Report Released :03/04/2024 07:48
Sent By: Direct

UREA CREATININE
Test Result Unit Biological Ref. Range

Blood Urea 20.00 mg/dl 14-40 mg/d

Method: Urease UV/GLDH

S. Creatinine 0.90
Method: Jafe's Kinetic mg/d 0.7-1.2 mg/dl
(Collected At: 02/04/2024 20:26:42, Received At: 02/04/2024 20:26:42, Reported At: 03/04/2024 07:48:13)

CPK (TOTAL)
Test Result Unit Biological Ref. Range

CPK(TOTAL) 305.20 UIL 25-308 U/L

(Collected At: 02/04/2024 20:26:42, Receved At: 02/04/2024 20:26:42, Reported At: 02/04/2024 23:2744)

End Of Report

Dr. Sapana Deshpande

OrP HHPkOn BRhpande
DNDPathology), DPB
Reg N eg16
DIAMND SUPERSPECIALITY HOSPITAL
(Venture of Kolhapur Superspeciality Medical Center LLP
184 A/ Part 1, E Ward, Near Mahaveer College, Nagala Park,
Kolhapur. Ph.: 0231-2667044 /0231-2667045

PATHOLOGY REPORT

80 020924
LAB ID :80 Sample Collection: 02/04/2024 20:26
Name : MR. ANANDA JAGANATH JADHAV Age 53 Yrs. Sex: M Sample Received :02/04/2024 20:26
Ref. By: DR. KAUSTUBH AURANGABADKAR :02/04/2024 23:27
Printed :03/04/2024 10:11 Report Released
Sent By: Direct

THYROID FUNCTION TEST

Result Unit Biological Ref. Range
Test

T3 119.3 ng/dl 50-200 ng/d

13.6 mcg/dl 4.4-10.8 mcg/dl

4

9.01 mlU/ml 0.28-6.82 mlU/ml

TSH

TEST DONE WITH iFlash 1200 Chemiluminescence Immunoassay Analyzer

NOTE: ROCH E 411 By Eclia ( immunoassay

Primary mafunction of thyroid gland may result in excessive (hyper) or below normal (hypo) release of T3 or T4. In addition, as TSH directly affects
thyrold function, malfunctin of pituitary or the hypothalamus influences the thyrold gland activity. Disease of any portion the thyroid-pituitary-
blood.
hypothalamus system may influence the levels of T3 and T4 in the

TSH (ulUml)
| FOR PREGNANT WOMEN T3(ng/di) T4 (ng/d )
0.0878-2.8
1 st TRIMESTER 81.1-176.6 5.61-13.3
7.3614.18 0.1998-2.8
2 nd TRIMESTER 92.8-205.1
0.307-2.9
3 rd TRIMESTER 90.9-205.1 | 7.37-15.02
ET T TETZ fundamentals of clinical chemistry 2. guidlines of the American thyroid association durling pregnancy and postpartum, 2011.

e d Ar 0204/2024 20:26:42, Recelved At: 02/04/2024 20:2642, Reported At 02/04/2024 23:27:44)

End Of Report

Dr. Sapana Deshpande

or. aAUOgYipanc
DNB (Pathology), DP
Reg. No. 2007040816
DIAM ND
SUPERSPECIALITY HOSPITAL
Dr. Kaustubh Aurangabadkar
D. M. (Neurology, AllMS)
Neurologlst
(Venture of Kolhapur Superspeciality Medical Center LP Regd. No.:081471
184 A/ Part-1, E Ward, Near Mahaveer College, Nagala Park,
Kolhapur. Ph.: 0231 -2667044/ 0231 -2667045
B Date
8/4124

PET-e
- P U Y s i oTCERAHY

COnsult Dy
banugade e 1 TSH

Kiqr
-1

moniis CBCTFT

T QNENS (SUO)
-X