Albert J. Moreno

Painless giant cell thyroiditis diagnosed by fine needle aspiration and associated with intense thyroidal uptake of gallium

A 52-year-old woman presented with fever, goiter, and no evidence of pain or tenderness in the thyroid. A diagnosis of silent thyroiditis was made after obtaining evidence of biochemical thyrotoxicosis, intense gallium-67 citrate thyroidal localization, and cytologic thyroiditis. Fine needle aspiration biopsy of the thyroid revealed numerous giant cells in all areas of the thyroid, typical of subacute thyroiditis. This is believed to be the first time painless thyroiditis is reported with the classic cytologic feature of painful subacute thyroiditis.

Extensive extraskeletal osteosarcoma in the liver and abdomen as demonstrated by bone scintigraphy.

A 66-year-old man had abdominal pain and ascites. Eight months previously, he had an exploratory laparotomy in which a 21-pound extraskeletal retroperitoneal osteosarcoma was resected. Recent bone scintigraphy demonstrated extensive peritoneal and hepatic metastatic foci. Computed tomography demonstrated calcified metastases within the liver and within the peritoneum.

Abdominal varices mimicking an acute gastrointestinal hemorrhage during technetium-99m red blood cell scintigraphy

Abdominal varices consisting of a caput medusae and dilated mesenteric veins resulted in pooling of Tc-99m tagged red blood cells (RBC) within these dilated vessels in a 57-year-old man with severe Laennecs cirrhosis. The atypical radiotracer localization within the abdomen mimicked an acute gastrointestinal hemorrhage. Clinical suspicion and careful evaluation of scintigraphic gastrointestinal bleeding studies will avoid false-positive interpretations.

Scintigraphic findings in a primary cerebral amyloidoma.

Bone, brain, and gallium scintigrams are presented of a 48-year-old man with biopsy-proven cerebral amyloidosis. Brain scintigraphy revealed a wellcircumscribed accumulation of Tc-99m pertechnetate in the amyloidoma. Bone scintigraphy using Tc-99m methylenediphosphonate likewise exhibited increased activity in the same area. Gallium-67 citrate, however, failed to localize within the amyloidoma.

One-Dose Technetium-99m Pertechnetate Imaging in Acute Testicular Torsion Followed by Manual Detorsion

The role of technetium-99m pertechnetate imaging in acute testicular torsion is well appreciated. Manual testicular detorsion under local anesthesia may be performed in the nuclear medicine clinic by the urology service immediately following initial diagnostic scintigraphy. Following manual testicular detorsion, continued images of the testes are obtained up to 30 minutes without having to reinject the patient with technetium-99m pertechnetate. Reperfusion of the affected testicle will be dramatically noted if the manual detorsion is successful. Four cases are presented to illustrate this.

Nuclear imaging in Coccidioidal osteomyelitis.

Six cases of osteomyelitis due to Coccidioides immitis are presented. The cases reported demonstrate the importance of performing both bone and gallium imaging to avoid missing the osseous coccidioidal lesions.

Ruptured abdominal aortic aneurysm identified incidental to bone scintigraphy

A report is presented of a man who had a ruptured abdominal aortic aneurysm identified incidental to bone scintigraphy. The bone scan revealed displacement of the left kidney to nearly a horizontal axis and indicated the need for more definitive evaluation. Renal scintigraphy and computed tomography correctly demonstrated a ruptured, but contained abdominal aortic aneurysm.

Angiographic and scintigraphic findings in fibrosing mediastinitis.

The clinical and morphologic findings in the case of a 47-year-old man with fibrosing mediastinitis, most probably due to histoplasmosis, are described. Radionuclide angiography demonstrated obstruction of the superior vena cava with collateral vascularization. Computed tomography demonstrated a large calcific mass interposed between the pulmonary artery and superior vena cava suggesting potential pulmonary vasculature involvement. For this reason, pulmonary scintigraphy was performed which showed right lung perfusion and ventilation defects. Radionuclide angiography and pulmonary scintigraphy complement each other in determining the extent of vascular involvement with fibrosing mediastinitis. However, contrast venography is necessary to correctly delineate the anatomy of the obstructed superior vena cava and its collaterals.

The effect of prolonged fasting and total parenteral nutrition on hepatobiliary imaging with technetium-99m DISIDA.

Prolonged fasting (NPO) and total parenteral nutrition (TPN) have been reported to result in an unacceptable number of false-positive hepatobiliary scintigrams for acute cholecystitis. Based on these reports, the clinical usefulness of the hepatobiliary scan in diagnosing acute cholecystitis in the critically ill postoperative patient who has been NPO or on TPN has been questioned. Patients who were either on prolonged fasting or total parenteral nutrition and who had no history of hepatobiliary disease were prospectively studied to assess the value of the Tc-99m diisopropyl-iminodiacetic acid (DISIDA) scan without pretreatment with cholecystokinin (CCK) in such a setting. Of the 17 persons studied, nine had been on total parenteral nutrition for at least five days and eight had been fasting for at least five days prior to imaging. Seven of the nine individuals on TPN (78%) and six of the eight individuals who were NPO (75%) had normal hepatobiliary scintigraphy. The results suggest that hepatobiliary imaging with Tc-99m DISIDA has a lower false-positive rate in individuals on TPN or NPO than previously has been reported and that it has clinical efficacy in ruling out the diagnosis of acute cholecystitis in these individuals.

Bone scintigraphy in latent congenital syphilis

A 26-year-old man with congenital syphilis presented with increased periosteal uptake of Tc-99m MDP during bone scintigraphy. In addition, bowing of the tibias and apparent shortening of the tibias were seen on the bone scan. Corresponding abnormalities were noted on roentgenography of the lower extremities.