Ana A. Rodriguez

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.

Adenomyosis as seen on blood flow and blood pool imaging during bone scintigraphy

A 42-year-old woman presented with intermittent low back and left lower extremity pain. The blood flow and blood pool images of bone scintigraphy showed a large focus of increased activity in the right lower abdomen. Computed tomography showed an enlarged uterus displaced to the right side of the pelvis. At surgery, the uterus was found to be involved with adenomyosis. Three-phase bone scintigraphy consisting of blood flow and blood pool images over the anterior pelvis may be a valuable diagnostic aid in the evaluation of lower back or pelvic pain of a woman.

Serendipitous finding of transitional cell carcinoma of the kidney on bone and gallium imaging

A 50-year-old woman presented with low back pain. Bone scintigraphy showed a focus of increased activity in the upper pole of the left kidney. Subsequent Ga-67 citrate scintigraphy demonstrated this same abnormal focus as a region of increased activity. Ultrasonography showed a renal mass in the upper pole of the left kidney. At surgery a transitional cell carcinoma of the upper pole of the left kidney was found.

Acute cholecystitis in a patient with situs inversus.

A 73-year-old woman with situs inversus presented with left upper quadrant abdominal pain. Nonvisualization of the gallbladder consistent with acute cholecystitis was noted throughout the study. Situs inversus of the liver and bowel was clearly demonstrated.

Imaging in plague

An 8-year-old boy presented with elevated temperature, malaise, hepatoslpenomegaly, mesenteric adenitis, and septic shock. Cultures of biopsied abdominal lymph nodes as well as the blood grew Yersinia pestes. The boys condition improved after two weeks of chloramphenicol and cefotaxime (Claforan). Two days after stopping intravenous antibiotic therapy, the patient again became febrile and complained of abdominal pain. Abdominal imaging with 111In-labeled leukocytes did not show any abnormalities, however, 67Ga-citrate scintigraphy demonstrated an abnormal focus of increased radiopharmaceutical uptake within a confluence of necrosed lymph nodes within the right upper quadrant of the abdomen. In addition, abnormal 67Ga-uptake was seen within the left hip region. Correlative imaging with computed tomography is also presented.

Gallbladder perforation seen on hepatobiliary imaging following morphine sulfate injection

A case of gallbladder perforation imaged during morphine-augmented cholescintigraphy is presented. Tc-99m DISIDA imaging dramatically demonstrated the bile leak. Whether morphine sulfate contributed to the perforation of the gallbladder is debatable.

The Value of Obtaining Renal Images Following Brain Scintigraphy with Technetium-99m Glucoheptonate

The value of adding an extra view of the kidneys immediately following brain imaging with Tc-99m glucoheptonate was investigated in a two-year retrospective study at our institution. Between October 1982 and October 1984, 561 individuals underwent Tc-99m glucoheptonate brain imaging with the added renal view. Twentynine of these individuals (5.2%) demonstrated renal abnormalities. The abnormal renal findings were clinically correlated in 24 of these persons. Sixteen (67%) of these 24 individuals were unaware of any renal abnormality. Useful information can be obtained from renal images incidental to brain imaging at no added expense or radiation exposure to the patient, and at a minimal cost in time to the imaging clinic.

Combined common bile duct and gastric outlet obstruction demonstrated during hepatobiliary scintigraphy.

A 64-year-old man presented with jaundice. Hepatobiliary imaging using 99mTc-DISIDA revealed complete hepatobiliary tract obstruction with a photopenic area corresponding to a dilated gallbladder and a large photopenic region corresponding to a distended stomach as a result of gastric outlet obstruction. At surgery, carcinoma of the head of the pancreas was found to be the cause of the combined common bile duct and gastric outlet obstruction.